Laird Harrison

SAN FRANCISCO – Music therapy can improve symptoms of depression and agitation in residents with dementia, according to researchers who described an innovative program in the MJHS health system* in New York.

"There was a major drop in agitation after 2 weeks of music therapy," said Dr. Mary S. Mittelman, director of the psychosocial research and support programs at nearby Langone Medical Center, and statistical analyst for the pilot program. "Depression went way down."

While most nursing homes offer music as passive entertainment, the researchers tried to systematically engage residents as active participants who move in time to the music, sing, or play instruments.

Music may stimulate people with dementia in a way that language cannot, said Jan Maier, RN, of the Research Triangle Institute International in Durham, N.C., who offered background information on music therapy. "In dementia, the parts of the brain that have to do with music and emotional memory are preserved," she said.

She cited anecdotal reports of people with dementia learning three-part rounds or recalling the words to long hymns they sang in their youth. In some documented cases, former professional musicians with such severe dementia that they couldn’t dress themselves have been able to play instruments in ensembles, she said.

"People who don’t remember their son or daughter who come to visit will remember the person who leads their music group, and say, ‘Do we have music today?’ " Ms. Maier said.

Photo courtesy Metropolitan Jewish Health System

A handful of randomized controlled trials have shown reductions in agitation in patients with dementia who participate in music therapy, she said, citing among other studies one by researchers in Taipei, Taiwan, that recently documented the effect (Int. J. Geriatr. Psychiatry 2011 July;26:670-8 [doi: 10.1002/gps.2580]).

Music therapy has great potential in long-term care, Dr. Mittelman said, since about 70% of nursing home residents over age 75 years suffer from dementia.

The MJHS health system* developed protocols in which the residents sang along or moved in time to the music, and others that incorporated music into activities of daily living, such as wound care, bathing, and range-of-motion exercises.

In a video demonstrating a typical session, women waved scarves in time to big band music. "The movement intervention worked best," said Kendra Ray, a music therapist* who directed the project.

Dr. Mittelman said the researchers collected data on 84 people, of whom 8 had agitation, 42 had depression, and 34 were wanderers. The research showed an average one-third drop on the Cohen-Mansfield Agitation Inventory and a similar improvement in depression, measured by the Dementia Mood Picture Test. Depression returned when the music therapists left and certified nursing assistants took over the activities. Results from the Algase Wandering Scale were inconsistent. Dr. Mittelman acknowledged that the data were only preliminary and that larger studies should be conducted.

But, as another measure of success, Dr. Mittelman said that some of the participants’ families testified about the benefits of the program. Some said that they enjoyed their visits more because the residents’ moods had improved so much. "My Mom is more upbeat, more attentive, and talkative," one wrote. And, at times, residents picked up instruments to practice on their own, outside of music-therapy hours.

If you are trying to address specific behaviors, Dr. Mittelman advised, time the therapy for when these behaviors are likely to occur. For example, if someone wanders in the evening, play music at that time. But don’t play music all day. That can become irritating, she said.

When designing a music-therapy program for an individual, "Pick the music that person loved," Dr. Mittelman said. "If you don’t know, go to their early adult years. If they like it, they’ll let you know right away."

Dr. Mittelman and Ms. Ray said they had no conflict of interest on the topic.

* CORRECTION, 6/3/2011: The original version of this article referred to the MJHS health system as the Metropolitan Jewish Health System. This version has been updated. Also, Kendra Ray was incorrectly referred to as an art therapist. She is a music therapist. We regret the error.

SAN FRANCISCO – Music therapy can improve symptoms of depression and agitation in residents with dementia, according to researchers who described an innovative program in the MJHS health system* in New York.

"There was a major drop in agitation after 2 weeks of music therapy," said Dr. Mary S. Mittelman, director of the psychosocial research and support programs at nearby Langone Medical Center, and statistical analyst for the pilot program. "Depression went way down."

While most nursing homes offer music as passive entertainment, the researchers tried to systematically engage residents as active participants who move in time to the music, sing, or play instruments.

Music may stimulate people with dementia in a way that language cannot, said Jan Maier, RN, of the Research Triangle Institute International in Durham, N.C., who offered background information on music therapy. "In dementia, the parts of the brain that have to do with music and emotional memory are preserved," she said.

She cited anecdotal reports of people with dementia learning three-part rounds or recalling the words to long hymns they sang in their youth. In some documented cases, former professional musicians with such severe dementia that they couldn’t dress themselves have been able to play instruments in ensembles, she said.

"People who don’t remember their son or daughter who come to visit will remember the person who leads their music group, and say, ‘Do we have music today?’ " Ms. Maier said.

Photo courtesy Metropolitan Jewish Health System

A handful of randomized controlled trials have shown reductions in agitation in patients with dementia who participate in music therapy, she said, citing among other studies one by researchers in Taipei, Taiwan, that recently documented the effect (Int. J. Geriatr. Psychiatry 2011 July;26:670-8 [doi: 10.1002/gps.2580]).

Music therapy has great potential in long-term care, Dr. Mittelman said, since about 70% of nursing home residents over age 75 years suffer from dementia.

The MJHS health system* developed protocols in which the residents sang along or moved in time to the music, and others that incorporated music into activities of daily living, such as wound care, bathing, and range-of-motion exercises.

In a video demonstrating a typical session, women waved scarves in time to big band music. "The movement intervention worked best," said Kendra Ray, a music therapist* who directed the project.

Dr. Mittelman said the researchers collected data on 84 people, of whom 8 had agitation, 42 had depression, and 34 were wanderers. The research showed an average one-third drop on the Cohen-Mansfield Agitation Inventory and a similar improvement in depression, measured by the Dementia Mood Picture Test. Depression returned when the music therapists left and certified nursing assistants took over the activities. Results from the Algase Wandering Scale were inconsistent. Dr. Mittelman acknowledged that the data were only preliminary and that larger studies should be conducted.

But, as another measure of success, Dr. Mittelman said that some of the participants’ families testified about the benefits of the program. Some said that they enjoyed their visits more because the residents’ moods had improved so much. "My Mom is more upbeat, more attentive, and talkative," one wrote. And, at times, residents picked up instruments to practice on their own, outside of music-therapy hours.

If you are trying to address specific behaviors, Dr. Mittelman advised, time the therapy for when these behaviors are likely to occur. For example, if someone wanders in the evening, play music at that time. But don’t play music all day. That can become irritating, she said.

When designing a music-therapy program for an individual, "Pick the music that person loved," Dr. Mittelman said. "If you don’t know, go to their early adult years. If they like it, they’ll let you know right away."

Dr. Mittelman and Ms. Ray said they had no conflict of interest on the topic.

* CORRECTION, 6/3/2011: The original version of this article referred to the MJHS health system as the Metropolitan Jewish Health System. This version has been updated. Also, Kendra Ray was incorrectly referred to as an art therapist. She is a music therapist. We regret the error.

SAN FRANCISCO – Music therapy can improve symptoms of depression and agitation in residents with dementia, according to researchers who described an innovative program in the MJHS health system* in New York.

"There was a major drop in agitation after 2 weeks of music therapy," said Dr. Mary S. Mittelman, director of the psychosocial research and support programs at nearby Langone Medical Center, and statistical analyst for the pilot program. "Depression went way down."

While most nursing homes offer music as passive entertainment, the researchers tried to systematically engage residents as active participants who move in time to the music, sing, or play instruments.

Music may stimulate people with dementia in a way that language cannot, said Jan Maier, RN, of the Research Triangle Institute International in Durham, N.C., who offered background information on music therapy. "In dementia, the parts of the brain that have to do with music and emotional memory are preserved," she said.

She cited anecdotal reports of people with dementia learning three-part rounds or recalling the words to long hymns they sang in their youth. In some documented cases, former professional musicians with such severe dementia that they couldn’t dress themselves have been able to play instruments in ensembles, she said.

"People who don’t remember their son or daughter who come to visit will remember the person who leads their music group, and say, ‘Do we have music today?’ " Ms. Maier said.

Photo courtesy Metropolitan Jewish Health System

A handful of randomized controlled trials have shown reductions in agitation in patients with dementia who participate in music therapy, she said, citing among other studies one by researchers in Taipei, Taiwan, that recently documented the effect (Int. J. Geriatr. Psychiatry 2011 July;26:670-8 [doi: 10.1002/gps.2580]).

Music therapy has great potential in long-term care, Dr. Mittelman said, since about 70% of nursing home residents over age 75 years suffer from dementia.

The MJHS health system* developed protocols in which the residents sang along or moved in time to the music, and others that incorporated music into activities of daily living, such as wound care, bathing, and range-of-motion exercises.

In a video demonstrating a typical session, women waved scarves in time to big band music. "The movement intervention worked best," said Kendra Ray, a music therapist* who directed the project.

Dr. Mittelman said the researchers collected data on 84 people, of whom 8 had agitation, 42 had depression, and 34 were wanderers. The research showed an average one-third drop on the Cohen-Mansfield Agitation Inventory and a similar improvement in depression, measured by the Dementia Mood Picture Test. Depression returned when the music therapists left and certified nursing assistants took over the activities. Results from the Algase Wandering Scale were inconsistent. Dr. Mittelman acknowledged that the data were only preliminary and that larger studies should be conducted.

But, as another measure of success, Dr. Mittelman said that some of the participants’ families testified about the benefits of the program. Some said that they enjoyed their visits more because the residents’ moods had improved so much. "My Mom is more upbeat, more attentive, and talkative," one wrote. And, at times, residents picked up instruments to practice on their own, outside of music-therapy hours.

If you are trying to address specific behaviors, Dr. Mittelman advised, time the therapy for when these behaviors are likely to occur. For example, if someone wanders in the evening, play music at that time. But don’t play music all day. That can become irritating, she said.

When designing a music-therapy program for an individual, "Pick the music that person loved," Dr. Mittelman said. "If you don’t know, go to their early adult years. If they like it, they’ll let you know right away."

Dr. Mittelman and Ms. Ray said they had no conflict of interest on the topic.

* CORRECTION, 6/3/2011: The original version of this article referred to the MJHS health system as the Metropolitan Jewish Health System. This version has been updated. Also, Kendra Ray was incorrectly referred to as an art therapist. She is a music therapist. We regret the error.

SAN FRANCISCO – Music therapy can improve symptoms of depression and agitation in residents with dementia, according to researchers who described an innovative program in the MJHS health system* in New York.

"There was a major drop in agitation after 2 weeks of music therapy," said Dr. Mary S. Mittelman, director of the psychosocial research and support programs at nearby Langone Medical Center, and statistical analyst for the pilot program. "Depression went way down."

While most nursing homes offer music as passive entertainment, the researchers tried to systematically engage residents as active participants who move in time to the music, sing, or play instruments.

Music may stimulate people with dementia in a way that language cannot, said Jan Maier, RN, of the Research Triangle Institute International in Durham, N.C., who offered background information on music therapy. "In dementia, the parts of the brain that have to do with music and emotional memory are preserved," she said.

She cited anecdotal reports of people with dementia learning three-part rounds or recalling the words to long hymns they sang in their youth. In some documented cases, former professional musicians with such severe dementia that they couldn’t dress themselves have been able to play instruments in ensembles, she said.

"People who don’t remember their son or daughter who come to visit will remember the person who leads their music group, and say, ‘Do we have music today?’ " Ms. Maier said.

Photo courtesy Metropolitan Jewish Health System

A handful of randomized controlled trials have shown reductions in agitation in patients with dementia who participate in music therapy, she said, citing among other studies one by researchers in Taipei, Taiwan, that recently documented the effect (Int. J. Geriatr. Psychiatry 2011 July;26:670-8 [doi: 10.1002/gps.2580]).

Music therapy has great potential in long-term care, Dr. Mittelman said, since about 70% of nursing home residents over age 75 years suffer from dementia.

The MJHS health system* developed protocols in which the residents sang along or moved in time to the music, and others that incorporated music into activities of daily living, such as wound care, bathing, and range-of-motion exercises.

In a video demonstrating a typical session, women waved scarves in time to big band music. "The movement intervention worked best," said Kendra Ray, a music therapist* who directed the project.

Dr. Mittelman said the researchers collected data on 84 people, of whom 8 had agitation, 42 had depression, and 34 were wanderers. The research showed an average one-third drop on the Cohen-Mansfield Agitation Inventory and a similar improvement in depression, measured by the Dementia Mood Picture Test. Depression returned when the music therapists left and certified nursing assistants took over the activities. Results from the Algase Wandering Scale were inconsistent. Dr. Mittelman acknowledged that the data were only preliminary and that larger studies should be conducted.

But, as another measure of success, Dr. Mittelman said that some of the participants’ families testified about the benefits of the program. Some said that they enjoyed their visits more because the residents’ moods had improved so much. "My Mom is more upbeat, more attentive, and talkative," one wrote. And, at times, residents picked up instruments to practice on their own, outside of music-therapy hours.

If you are trying to address specific behaviors, Dr. Mittelman advised, time the therapy for when these behaviors are likely to occur. For example, if someone wanders in the evening, play music at that time. But don’t play music all day. That can become irritating, she said.

When designing a music-therapy program for an individual, "Pick the music that person loved," Dr. Mittelman said. "If you don’t know, go to their early adult years. If they like it, they’ll let you know right away."

Dr. Mittelman and Ms. Ray said they had no conflict of interest on the topic.

* CORRECTION, 6/3/2011: The original version of this article referred to the MJHS health system as the Metropolitan Jewish Health System. This version has been updated. Also, Kendra Ray was incorrectly referred to as an art therapist. She is a music therapist. We regret the error.

SAN FRANCISCO – Music therapy can improve symptoms of depression and agitation in residents with dementia, according to researchers who described an innovative program in the MJHS health system* in New York.

"There was a major drop in agitation after 2 weeks of music therapy," said Dr. Mary S. Mittelman, director of the psychosocial research and support programs at nearby Langone Medical Center, and statistical analyst for the pilot program. "Depression went way down."

While most nursing homes offer music as passive entertainment, the researchers tried to systematically engage residents as active participants who move in time to the music, sing, or play instruments.

Music may stimulate people with dementia in a way that language cannot, said Jan Maier, RN, of the Research Triangle Institute International in Durham, N.C., who offered background information on music therapy. "In dementia, the parts of the brain that have to do with music and emotional memory are preserved," she said.

She cited anecdotal reports of people with dementia learning three-part rounds or recalling the words to long hymns they sang in their youth. In some documented cases, former professional musicians with such severe dementia that they couldn’t dress themselves have been able to play instruments in ensembles, she said.

"People who don’t remember their son or daughter who come to visit will remember the person who leads their music group, and say, ‘Do we have music today?’ " Ms. Maier said.

Photo courtesy Metropolitan Jewish Health System

A handful of randomized controlled trials have shown reductions in agitation in patients with dementia who participate in music therapy, she said, citing among other studies one by researchers in Taipei, Taiwan, that recently documented the effect (Int. J. Geriatr. Psychiatry 2011 July;26:670-8 [doi: 10.1002/gps.2580]).

Music therapy has great potential in long-term care, Dr. Mittelman said, since about 70% of nursing home residents over age 75 years suffer from dementia.

The MJHS health system* developed protocols in which the residents sang along or moved in time to the music, and others that incorporated music into activities of daily living, such as wound care, bathing, and range-of-motion exercises.

In a video demonstrating a typical session, women waved scarves in time to big band music. "The movement intervention worked best," said Kendra Ray, a music therapist* who directed the project.

Dr. Mittelman said the researchers collected data on 84 people, of whom 8 had agitation, 42 had depression, and 34 were wanderers. The research showed an average one-third drop on the Cohen-Mansfield Agitation Inventory and a similar improvement in depression, measured by the Dementia Mood Picture Test. Depression returned when the music therapists left and certified nursing assistants took over the activities. Results from the Algase Wandering Scale were inconsistent. Dr. Mittelman acknowledged that the data were only preliminary and that larger studies should be conducted.

But, as another measure of success, Dr. Mittelman said that some of the participants’ families testified about the benefits of the program. Some said that they enjoyed their visits more because the residents’ moods had improved so much. "My Mom is more upbeat, more attentive, and talkative," one wrote. And, at times, residents picked up instruments to practice on their own, outside of music-therapy hours.

If you are trying to address specific behaviors, Dr. Mittelman advised, time the therapy for when these behaviors are likely to occur. For example, if someone wanders in the evening, play music at that time. But don’t play music all day. That can become irritating, she said.

When designing a music-therapy program for an individual, "Pick the music that person loved," Dr. Mittelman said. "If you don’t know, go to their early adult years. If they like it, they’ll let you know right away."

Dr. Mittelman and Ms. Ray said they had no conflict of interest on the topic.

* CORRECTION, 6/3/2011: The original version of this article referred to the MJHS health system as the Metropolitan Jewish Health System. This version has been updated. Also, Kendra Ray was incorrectly referred to as an art therapist. She is a music therapist. We regret the error.

SAN FRANCISCO – Music therapy can improve symptoms of depression and agitation in residents with dementia, according to researchers who described an innovative program in the MJHS health system* in New York.

"There was a major drop in agitation after 2 weeks of music therapy," said Dr. Mary S. Mittelman, director of the psychosocial research and support programs at nearby Langone Medical Center, and statistical analyst for the pilot program. "Depression went way down."

While most nursing homes offer music as passive entertainment, the researchers tried to systematically engage residents as active participants who move in time to the music, sing, or play instruments.

Music may stimulate people with dementia in a way that language cannot, said Jan Maier, RN, of the Research Triangle Institute International in Durham, N.C., who offered background information on music therapy. "In dementia, the parts of the brain that have to do with music and emotional memory are preserved," she said.

She cited anecdotal reports of people with dementia learning three-part rounds or recalling the words to long hymns they sang in their youth. In some documented cases, former professional musicians with such severe dementia that they couldn’t dress themselves have been able to play instruments in ensembles, she said.

"People who don’t remember their son or daughter who come to visit will remember the person who leads their music group, and say, ‘Do we have music today?’ " Ms. Maier said.

Photo courtesy Metropolitan Jewish Health System

A handful of randomized controlled trials have shown reductions in agitation in patients with dementia who participate in music therapy, she said, citing among other studies one by researchers in Taipei, Taiwan, that recently documented the effect (Int. J. Geriatr. Psychiatry 2011 July;26:670-8 [doi: 10.1002/gps.2580]).

Music therapy has great potential in long-term care, Dr. Mittelman said, since about 70% of nursing home residents over age 75 years suffer from dementia.

The MJHS health system* developed protocols in which the residents sang along or moved in time to the music, and others that incorporated music into activities of daily living, such as wound care, bathing, and range-of-motion exercises.

In a video demonstrating a typical session, women waved scarves in time to big band music. "The movement intervention worked best," said Kendra Ray, a music therapist* who directed the project.

Dr. Mittelman said the researchers collected data on 84 people, of whom 8 had agitation, 42 had depression, and 34 were wanderers. The research showed an average one-third drop on the Cohen-Mansfield Agitation Inventory and a similar improvement in depression, measured by the Dementia Mood Picture Test. Depression returned when the music therapists left and certified nursing assistants took over the activities. Results from the Algase Wandering Scale were inconsistent. Dr. Mittelman acknowledged that the data were only preliminary and that larger studies should be conducted.

But, as another measure of success, Dr. Mittelman said that some of the participants’ families testified about the benefits of the program. Some said that they enjoyed their visits more because the residents’ moods had improved so much. "My Mom is more upbeat, more attentive, and talkative," one wrote. And, at times, residents picked up instruments to practice on their own, outside of music-therapy hours.

If you are trying to address specific behaviors, Dr. Mittelman advised, time the therapy for when these behaviors are likely to occur. For example, if someone wanders in the evening, play music at that time. But don’t play music all day. That can become irritating, she said.

When designing a music-therapy program for an individual, "Pick the music that person loved," Dr. Mittelman said. "If you don’t know, go to their early adult years. If they like it, they’ll let you know right away."

Dr. Mittelman and Ms. Ray said they had no conflict of interest on the topic.

* CORRECTION, 6/3/2011: The original version of this article referred to the MJHS health system as the Metropolitan Jewish Health System. This version has been updated. Also, Kendra Ray was incorrectly referred to as an art therapist. She is a music therapist. We regret the error.

SAN FRANCISCO – Music therapy can improve symptoms of depression and agitation in residents with dementia, according to researchers who described an innovative program in the MJHS health system* in New York.

"There was a major drop in agitation after 2 weeks of music therapy," said Dr. Mary S. Mittelman, director of the psychosocial research and support programs at nearby Langone Medical Center, and statistical analyst for the pilot program. "Depression went way down."

While most nursing homes offer music as passive entertainment, the researchers tried to systematically engage residents as active participants who move in time to the music, sing, or play instruments.

Music may stimulate people with dementia in a way that language cannot, said Jan Maier, RN, of the Research Triangle Institute International in Durham, N.C., who offered background information on music therapy. "In dementia, the parts of the brain that have to do with music and emotional memory are preserved," she said.

She cited anecdotal reports of people with dementia learning three-part rounds or recalling the words to long hymns they sang in their youth. In some documented cases, former professional musicians with such severe dementia that they couldn’t dress themselves have been able to play instruments in ensembles, she said.

"People who don’t remember their son or daughter who come to visit will remember the person who leads their music group, and say, ‘Do we have music today?’ " Ms. Maier said.

Photo courtesy Metropolitan Jewish Health System

A handful of randomized controlled trials have shown reductions in agitation in patients with dementia who participate in music therapy, she said, citing among other studies one by researchers in Taipei, Taiwan, that recently documented the effect (Int. J. Geriatr. Psychiatry 2011 July;26:670-8 [doi: 10.1002/gps.2580]).

Music therapy has great potential in long-term care, Dr. Mittelman said, since about 70% of nursing home residents over age 75 years suffer from dementia.

The MJHS health system* developed protocols in which the residents sang along or moved in time to the music, and others that incorporated music into activities of daily living, such as wound care, bathing, and range-of-motion exercises.

In a video demonstrating a typical session, women waved scarves in time to big band music. "The movement intervention worked best," said Kendra Ray, a music therapist* who directed the project.

Dr. Mittelman said the researchers collected data on 84 people, of whom 8 had agitation, 42 had depression, and 34 were wanderers. The research showed an average one-third drop on the Cohen-Mansfield Agitation Inventory and a similar improvement in depression, measured by the Dementia Mood Picture Test. Depression returned when the music therapists left and certified nursing assistants took over the activities. Results from the Algase Wandering Scale were inconsistent. Dr. Mittelman acknowledged that the data were only preliminary and that larger studies should be conducted.

But, as another measure of success, Dr. Mittelman said that some of the participants’ families testified about the benefits of the program. Some said that they enjoyed their visits more because the residents’ moods had improved so much. "My Mom is more upbeat, more attentive, and talkative," one wrote. And, at times, residents picked up instruments to practice on their own, outside of music-therapy hours.

If you are trying to address specific behaviors, Dr. Mittelman advised, time the therapy for when these behaviors are likely to occur. For example, if someone wanders in the evening, play music at that time. But don’t play music all day. That can become irritating, she said.

When designing a music-therapy program for an individual, "Pick the music that person loved," Dr. Mittelman said. "If you don’t know, go to their early adult years. If they like it, they’ll let you know right away."

Dr. Mittelman and Ms. Ray said they had no conflict of interest on the topic.

* CORRECTION, 6/3/2011: The original version of this article referred to the MJHS health system as the Metropolitan Jewish Health System. This version has been updated. Also, Kendra Ray was incorrectly referred to as an art therapist. She is a music therapist. We regret the error.

SAN FRANCISCO – Music therapy can improve symptoms of depression and agitation in residents with dementia, according to researchers who described an innovative program in the MJHS health system* in New York.

"There was a major drop in agitation after 2 weeks of music therapy," said Dr. Mary S. Mittelman, director of the psychosocial research and support programs at nearby Langone Medical Center, and statistical analyst for the pilot program. "Depression went way down."

While most nursing homes offer music as passive entertainment, the researchers tried to systematically engage residents as active participants who move in time to the music, sing, or play instruments.

Music may stimulate people with dementia in a way that language cannot, said Jan Maier, RN, of the Research Triangle Institute International in Durham, N.C., who offered background information on music therapy. "In dementia, the parts of the brain that have to do with music and emotional memory are preserved," she said.

She cited anecdotal reports of people with dementia learning three-part rounds or recalling the words to long hymns they sang in their youth. In some documented cases, former professional musicians with such severe dementia that they couldn’t dress themselves have been able to play instruments in ensembles, she said.

"People who don’t remember their son or daughter who come to visit will remember the person who leads their music group, and say, ‘Do we have music today?’ " Ms. Maier said.

Photo courtesy Metropolitan Jewish Health System

A handful of randomized controlled trials have shown reductions in agitation in patients with dementia who participate in music therapy, she said, citing among other studies one by researchers in Taipei, Taiwan, that recently documented the effect (Int. J. Geriatr. Psychiatry 2011 July;26:670-8 [doi: 10.1002/gps.2580]).

Music therapy has great potential in long-term care, Dr. Mittelman said, since about 70% of nursing home residents over age 75 years suffer from dementia.

The MJHS health system* developed protocols in which the residents sang along or moved in time to the music, and others that incorporated music into activities of daily living, such as wound care, bathing, and range-of-motion exercises.

In a video demonstrating a typical session, women waved scarves in time to big band music. "The movement intervention worked best," said Kendra Ray, a music therapist* who directed the project.

Dr. Mittelman said the researchers collected data on 84 people, of whom 8 had agitation, 42 had depression, and 34 were wanderers. The research showed an average one-third drop on the Cohen-Mansfield Agitation Inventory and a similar improvement in depression, measured by the Dementia Mood Picture Test. Depression returned when the music therapists left and certified nursing assistants took over the activities. Results from the Algase Wandering Scale were inconsistent. Dr. Mittelman acknowledged that the data were only preliminary and that larger studies should be conducted.

But, as another measure of success, Dr. Mittelman said that some of the participants’ families testified about the benefits of the program. Some said that they enjoyed their visits more because the residents’ moods had improved so much. "My Mom is more upbeat, more attentive, and talkative," one wrote. And, at times, residents picked up instruments to practice on their own, outside of music-therapy hours.

If you are trying to address specific behaviors, Dr. Mittelman advised, time the therapy for when these behaviors are likely to occur. For example, if someone wanders in the evening, play music at that time. But don’t play music all day. That can become irritating, she said.

When designing a music-therapy program for an individual, "Pick the music that person loved," Dr. Mittelman said. "If you don’t know, go to their early adult years. If they like it, they’ll let you know right away."

Dr. Mittelman and Ms. Ray said they had no conflict of interest on the topic.

* CORRECTION, 6/3/2011: The original version of this article referred to the MJHS health system as the Metropolitan Jewish Health System. This version has been updated. Also, Kendra Ray was incorrectly referred to as an art therapist. She is a music therapist. We regret the error.

SAN FRANCISCO – Music therapy can improve symptoms of depression and agitation in residents with dementia, according to researchers who described an innovative program in the MJHS health system* in New York.

"There was a major drop in agitation after 2 weeks of music therapy," said Dr. Mary S. Mittelman, director of the psychosocial research and support programs at nearby Langone Medical Center, and statistical analyst for the pilot program. "Depression went way down."

While most nursing homes offer music as passive entertainment, the researchers tried to systematically engage residents as active participants who move in time to the music, sing, or play instruments.

Music may stimulate people with dementia in a way that language cannot, said Jan Maier, RN, of the Research Triangle Institute International in Durham, N.C., who offered background information on music therapy. "In dementia, the parts of the brain that have to do with music and emotional memory are preserved," she said.

She cited anecdotal reports of people with dementia learning three-part rounds or recalling the words to long hymns they sang in their youth. In some documented cases, former professional musicians with such severe dementia that they couldn’t dress themselves have been able to play instruments in ensembles, she said.

"People who don’t remember their son or daughter who come to visit will remember the person who leads their music group, and say, ‘Do we have music today?’ " Ms. Maier said.

Photo courtesy Metropolitan Jewish Health System

A handful of randomized controlled trials have shown reductions in agitation in patients with dementia who participate in music therapy, she said, citing among other studies one by researchers in Taipei, Taiwan, that recently documented the effect (Int. J. Geriatr. Psychiatry 2011 July;26:670-8 [doi: 10.1002/gps.2580]).

Music therapy has great potential in long-term care, Dr. Mittelman said, since about 70% of nursing home residents over age 75 years suffer from dementia.

The MJHS health system* developed protocols in which the residents sang along or moved in time to the music, and others that incorporated music into activities of daily living, such as wound care, bathing, and range-of-motion exercises.

In a video demonstrating a typical session, women waved scarves in time to big band music. "The movement intervention worked best," said Kendra Ray, a music therapist* who directed the project.

Dr. Mittelman said the researchers collected data on 84 people, of whom 8 had agitation, 42 had depression, and 34 were wanderers. The research showed an average one-third drop on the Cohen-Mansfield Agitation Inventory and a similar improvement in depression, measured by the Dementia Mood Picture Test. Depression returned when the music therapists left and certified nursing assistants took over the activities. Results from the Algase Wandering Scale were inconsistent. Dr. Mittelman acknowledged that the data were only preliminary and that larger studies should be conducted.

But, as another measure of success, Dr. Mittelman said that some of the participants’ families testified about the benefits of the program. Some said that they enjoyed their visits more because the residents’ moods had improved so much. "My Mom is more upbeat, more attentive, and talkative," one wrote. And, at times, residents picked up instruments to practice on their own, outside of music-therapy hours.

If you are trying to address specific behaviors, Dr. Mittelman advised, time the therapy for when these behaviors are likely to occur. For example, if someone wanders in the evening, play music at that time. But don’t play music all day. That can become irritating, she said.

When designing a music-therapy program for an individual, "Pick the music that person loved," Dr. Mittelman said. "If you don’t know, go to their early adult years. If they like it, they’ll let you know right away."

Dr. Mittelman and Ms. Ray said they had no conflict of interest on the topic.

* CORRECTION, 6/3/2011: The original version of this article referred to the MJHS health system as the Metropolitan Jewish Health System. This version has been updated. Also, Kendra Ray was incorrectly referred to as an art therapist. She is a music therapist. We regret the error.

SAN FRANCISCO – Contrary to decades of tradition – and Sigmund Freud – psychotherapists working with frail elders should offer counseling on spirituality, according to three experts who have straddled the therapy-spirituality line in their own practices.

"I’m convinced you can take process psychology and marry it to theology," Jim Ellor, Ph.D., a professor of social work at Baylor University in Waco, Tex., said at the conference.

One reason that psychotherapists have avoided discussing their patients’ spirituality is that they confuse spirituality with religion, said Donald Koepke, director emeritus of the California Lutheran Homes Center for Spirituality and Aging, in Anaheim, Calif. Since the days of Sigmund Freud, who saw religion as a kind of neurosis, psychotherapists have been taught to avoid religion.

"While everyone may not have a religion, or be what we call religious, everyone has spirituality," said Mr. Koepke. "It’s core beliefs. It’s what drives them and helps them to experience the world."

He gave the example of Audrey, a communist atheist he met in the nursing home where he worked as chaplain. When she was diagnosed with a terminal illness, Mr. Koepke visited her and asked how she felt about having little time left.

"I move over and make room for someone else," she answered. But she went on. "The purpose in life is to leave the world better than you found it," she said. "I have done that." She went on to describe her activism in the labor movement.

Mr. Koepke said he left Audrey’s room feeling that "she felt connected to that which was greater than herself."

He said that everyone has four spiritual needs: to find meaning; to give love; to receive love; and to feel forgiveness, hope, and creativity. Something about the experience of living in a nursing home gives people an opportunity to face these needs, he added. "The spiritually healthy people I know are almost all in skilled care. They are marvelous people to know."

Barry Kendall, Psy.D., a private-practice existential psychologist in Beverly Hills, Calif., said that what is called existential psychotherapy can help such patients answer spiritual questions. This approach, as described by Stanford (Calif.) University psychiatrist Dr. Irvin Yalom, deals with psychological conflicts as stemming from the inevitability of death, the responsibility of freedom, isolation, and the inherent meaninglessness of life.

"Inside psychotherapy, people for the first time begin to have a relationship with someone who understands them," he said. With some patients, the conversation may turn specifically to religion, for others it may stay more generally on the meaning of life, Dr. Kendall said. "For some patients who are theists, the explicit questions are helpful. For other patients, the implicit questions are helpful."

How can a therapist help patients with their spiritual problems? Listen to their experiences, advised Dr. Ellor. "Look for the threads that are consistent in their story. If they are talking about the spiritual, listen." When patients ask for a spiritual professional, for example to conduct rites specific to a religion, psychotherapists should step aside.

But when the question at hand is really about feelings, then psychotherapists should continue trying to meet their patients’ needs because the therapists know how to work with feelings. In that case, bringing in a religious professional can force the patient to start over again building a new relationship.

"Look at the whole person," Dr. Ellor advised.

SAN FRANCISCO – Contrary to decades of tradition – and Sigmund Freud – psychotherapists working with frail elders should offer counseling on spirituality, according to three experts who have straddled the therapy-spirituality line in their own practices.

"I’m convinced you can take process psychology and marry it to theology," Jim Ellor, Ph.D., a professor of social work at Baylor University in Waco, Tex., said at the conference.

One reason that psychotherapists have avoided discussing their patients’ spirituality is that they confuse spirituality with religion, said Donald Koepke, director emeritus of the California Lutheran Homes Center for Spirituality and Aging, in Anaheim, Calif. Since the days of Sigmund Freud, who saw religion as a kind of neurosis, psychotherapists have been taught to avoid religion.

"While everyone may not have a religion, or be what we call religious, everyone has spirituality," said Mr. Koepke. "It’s core beliefs. It’s what drives them and helps them to experience the world."

He gave the example of Audrey, a communist atheist he met in the nursing home where he worked as chaplain. When she was diagnosed with a terminal illness, Mr. Koepke visited her and asked how she felt about having little time left.

"I move over and make room for someone else," she answered. But she went on. "The purpose in life is to leave the world better than you found it," she said. "I have done that." She went on to describe her activism in the labor movement.

Mr. Koepke said he left Audrey’s room feeling that "she felt connected to that which was greater than herself."

He said that everyone has four spiritual needs: to find meaning; to give love; to receive love; and to feel forgiveness, hope, and creativity. Something about the experience of living in a nursing home gives people an opportunity to face these needs, he added. "The spiritually healthy people I know are almost all in skilled care. They are marvelous people to know."

Barry Kendall, Psy.D., a private-practice existential psychologist in Beverly Hills, Calif., said that what is called existential psychotherapy can help such patients answer spiritual questions. This approach, as described by Stanford (Calif.) University psychiatrist Dr. Irvin Yalom, deals with psychological conflicts as stemming from the inevitability of death, the responsibility of freedom, isolation, and the inherent meaninglessness of life.

"Inside psychotherapy, people for the first time begin to have a relationship with someone who understands them," he said. With some patients, the conversation may turn specifically to religion, for others it may stay more generally on the meaning of life, Dr. Kendall said. "For some patients who are theists, the explicit questions are helpful. For other patients, the implicit questions are helpful."

How can a therapist help patients with their spiritual problems? Listen to their experiences, advised Dr. Ellor. "Look for the threads that are consistent in their story. If they are talking about the spiritual, listen." When patients ask for a spiritual professional, for example to conduct rites specific to a religion, psychotherapists should step aside.

But when the question at hand is really about feelings, then psychotherapists should continue trying to meet their patients’ needs because the therapists know how to work with feelings. In that case, bringing in a religious professional can force the patient to start over again building a new relationship.

"Look at the whole person," Dr. Ellor advised.

SAN FRANCISCO – Contrary to decades of tradition – and Sigmund Freud – psychotherapists working with frail elders should offer counseling on spirituality, according to three experts who have straddled the therapy-spirituality line in their own practices.

"I’m convinced you can take process psychology and marry it to theology," Jim Ellor, Ph.D., a professor of social work at Baylor University in Waco, Tex., said at the conference.

One reason that psychotherapists have avoided discussing their patients’ spirituality is that they confuse spirituality with religion, said Donald Koepke, director emeritus of the California Lutheran Homes Center for Spirituality and Aging, in Anaheim, Calif. Since the days of Sigmund Freud, who saw religion as a kind of neurosis, psychotherapists have been taught to avoid religion.

"While everyone may not have a religion, or be what we call religious, everyone has spirituality," said Mr. Koepke. "It’s core beliefs. It’s what drives them and helps them to experience the world."

He gave the example of Audrey, a communist atheist he met in the nursing home where he worked as chaplain. When she was diagnosed with a terminal illness, Mr. Koepke visited her and asked how she felt about having little time left.

"I move over and make room for someone else," she answered. But she went on. "The purpose in life is to leave the world better than you found it," she said. "I have done that." She went on to describe her activism in the labor movement.

Mr. Koepke said he left Audrey’s room feeling that "she felt connected to that which was greater than herself."

He said that everyone has four spiritual needs: to find meaning; to give love; to receive love; and to feel forgiveness, hope, and creativity. Something about the experience of living in a nursing home gives people an opportunity to face these needs, he added. "The spiritually healthy people I know are almost all in skilled care. They are marvelous people to know."

Barry Kendall, Psy.D., a private-practice existential psychologist in Beverly Hills, Calif., said that what is called existential psychotherapy can help such patients answer spiritual questions. This approach, as described by Stanford (Calif.) University psychiatrist Dr. Irvin Yalom, deals with psychological conflicts as stemming from the inevitability of death, the responsibility of freedom, isolation, and the inherent meaninglessness of life.

"Inside psychotherapy, people for the first time begin to have a relationship with someone who understands them," he said. With some patients, the conversation may turn specifically to religion, for others it may stay more generally on the meaning of life, Dr. Kendall said. "For some patients who are theists, the explicit questions are helpful. For other patients, the implicit questions are helpful."

How can a therapist help patients with their spiritual problems? Listen to their experiences, advised Dr. Ellor. "Look for the threads that are consistent in their story. If they are talking about the spiritual, listen." When patients ask for a spiritual professional, for example to conduct rites specific to a religion, psychotherapists should step aside.

But when the question at hand is really about feelings, then psychotherapists should continue trying to meet their patients’ needs because the therapists know how to work with feelings. In that case, bringing in a religious professional can force the patient to start over again building a new relationship.

"Look at the whole person," Dr. Ellor advised.

LOS ANGELES – Practitioners treating Charcot foot have little evidence to guide them in selecting the right medicine, according to an international task force offering guidance on diagnosis and treatment of the condition.

Reporting on its January 2011 Paris meeting, task force cochair Lee C. Rogers, D.P.M., said the group of 18 experts from six countries took hours just to arrive at a definition of the syndrome. Ultimately, they decided that Charcot foot is an inflamed foot in a person with neuropathy.

The official report of the task force, convened by the American Diabetes Association (ADA) and the American Podiatric Medical Association, will be published in the journals of those organizations. Dr. Rogers of the amputation prevention center at Valley Presbyterian Hospital, Los Angeles, cautioned that he was offering only his personal observations on the proceedings.

"The major thing you’ll see in this task-force document is that there is very little evidence for any of the pharmacological treatments ... [But] that doesn’t mean we don’t use them in clinical practice," he said at the Diabetic Foot Global Conference, which was presented by Valley Presbyterian Hospital.

Although there are no good prevalence studies on Charcot foot, the task force estimated that 0.15%-1% of patients with diabetes suffer from the syndrome, said Dr. Rogers. There are 40,000 new cases a year in the United States. Patients with Charcot foot are more likely to suffer amputations, and may have a higher mortality rate, he said.

Having Charcot foot increases the risk of a foot ulcer 36 times, and 30% of patients with one Charcot foot have two Charcot feet. "It’s known that Charcot foot impacts the lifestyle of the individual, and often ... leads to permanent disability and premature retirement," Dr. Rogers said.

The syndrome appears to start with a traumatic event, which the patient may or may not remember. The trauma sparks inflammation. A patient with autonomic neuropathy may continue walking on the foot without feeling pain, leading to a cycle of fracture, subluxation, dislocation, and deformity.

"One of the things that is very important that came out of this meeting is that inflammation is the key to the pathogenesis of Charcot foot, and is also the key to diagnosis," said Dr. Rogers.

Charcot foot is often misdiagnosed, or diagnosed late. If clinicians can recognize the inflammation early on, they may be able to prevent the chain of events that leads to such conditions as rocker bottom foot later on.

The panel agreed that a Charcot foot should be classified as "active" if inflammation is continuing, or "inactive" if the inflammation has subsided. They thought this was more useful than the terms "acute" and "chronic," which only suggest how long the condition has been present.

The first step after suspecting Charcot foot is imaging, Dr. Rogers said. "What’s important when you’re trying to make a diagnosis based on imaging is that you have to incorporate a lot of the clinical findings to determine which type of imaging to perform: whether or not you suspect osteomyelitis, [or] whether there’s the presence of an ulcer."

He recommended starting with an x-ray to see whether there is bone destruction. MRI can’t be specific for Charcot foot vs. osteomyelitis unless you consider secondary signs, said Dr. Rogers, who noted the following:

• More than 90% of cases of osteomyelitis in diabetic foot are from contiguous spread, and the spread can be traced from an ulcer to the bone on MRI.

• Osteomyelitis primarily affects only one bone, whereas Charcot may affect multiple bones.

• Deformity is more common in Charcot foot than in osteomyelitis.

• Charcot foot is more often in the midfoot, whereas osteomyelitis is more common in the toes and forefoot.

Turning to medical treatments, Dr. Rogers said, "The most important thing you can do is offloading."

He recommended educating "other members of the team," such as emergency room physicians who may treat Charcot patients presenting with an injury and a swollen foot that has not yet been x-rayed. "Offloading and immobilization can avoid the later sequelae," said Dr. Rogers.

There is little research to compare a cast walker or a total contact cast, he said. Some on the panel recommend complete avoidance of weight bearing, he said. A Roll-A-Bout walker offers another alternative.

In one study, patients took a mean of 18.5 weeks of casting to quiescence (J. Am. Podiatr. Med. Assoc. 1997;6:272-8). "This is not something where you can tell the patient, ‘We’ll have you out of the cast and walking in 3 weeks,’ " said Dr. Rogers. "You have to explain to the patient [that] this is a long process."

After taking the load off a Charcot foot, practitioners can try bisphosphonates to treat the condition, Dr. Rogers said.

The two agents that have been studied for Charcot foot are pamidronate (Aredia) and alendronate (Fosamax). Pamidromate can be given in a single 90-mg intravenous dose. (You may have to answer questions from the pharmacy because of dosing requirements for patients with renal insufficiency, but there are no dosing requirements if you are giving the dose only once, because the half-life doesn’t really matter in that case, Dr. Rogers said.) Alendronate was given in oral doses of 70 mg weekly in one study in which it was compared with pamidronate for Charcot foot, and it took longer to achieve normal foot temperature.

Another drug studied for Charcot foot is intranasal calcitonin (Miacalcin), which "might make more pathological sense," said Dr. Rogers. It is sprayed once per day in alternating nostrils. It should be given in combination with vitamin D and calcium.

How do you determine whether any of these therapies is working? By using a contact thermometer, you can compare the Charcot foot to the non-Charcot foot. A difference between the two that is greater than 4° F (2° C) is considered significant for inflammation. "Make sure this gets back to [within a] 4° difference before you put them back in their normal footwear," said Dr. Rogers.

Thermal imaging is helpful with patient compliance because it helps the patient see the difference, he said.

After getting the patient into an inactive state, make sure the foot stays protected so it doesn’t develop an ulcer, Dr. Rogers said in conclusion.

Dr. Rogers said he had no conflicts of interest to disclose.

LOS ANGELES – Practitioners treating Charcot foot have little evidence to guide them in selecting the right medicine, according to an international task force offering guidance on diagnosis and treatment of the condition.

Reporting on its January 2011 Paris meeting, task force cochair Lee C. Rogers, D.P.M., said the group of 18 experts from six countries took hours just to arrive at a definition of the syndrome. Ultimately, they decided that Charcot foot is an inflamed foot in a person with neuropathy.

The official report of the task force, convened by the American Diabetes Association (ADA) and the American Podiatric Medical Association, will be published in the journals of those organizations. Dr. Rogers of the amputation prevention center at Valley Presbyterian Hospital, Los Angeles, cautioned that he was offering only his personal observations on the proceedings.

"The major thing you’ll see in this task-force document is that there is very little evidence for any of the pharmacological treatments ... [But] that doesn’t mean we don’t use them in clinical practice," he said at the Diabetic Foot Global Conference, which was presented by Valley Presbyterian Hospital.

Although there are no good prevalence studies on Charcot foot, the task force estimated that 0.15%-1% of patients with diabetes suffer from the syndrome, said Dr. Rogers. There are 40,000 new cases a year in the United States. Patients with Charcot foot are more likely to suffer amputations, and may have a higher mortality rate, he said.

Having Charcot foot increases the risk of a foot ulcer 36 times, and 30% of patients with one Charcot foot have two Charcot feet. "It’s known that Charcot foot impacts the lifestyle of the individual, and often ... leads to permanent disability and premature retirement," Dr. Rogers said.

The syndrome appears to start with a traumatic event, which the patient may or may not remember. The trauma sparks inflammation. A patient with autonomic neuropathy may continue walking on the foot without feeling pain, leading to a cycle of fracture, subluxation, dislocation, and deformity.

"One of the things that is very important that came out of this meeting is that inflammation is the key to the pathogenesis of Charcot foot, and is also the key to diagnosis," said Dr. Rogers.

Charcot foot is often misdiagnosed, or diagnosed late. If clinicians can recognize the inflammation early on, they may be able to prevent the chain of events that leads to such conditions as rocker bottom foot later on.

The panel agreed that a Charcot foot should be classified as "active" if inflammation is continuing, or "inactive" if the inflammation has subsided. They thought this was more useful than the terms "acute" and "chronic," which only suggest how long the condition has been present.

The first step after suspecting Charcot foot is imaging, Dr. Rogers said. "What’s important when you’re trying to make a diagnosis based on imaging is that you have to incorporate a lot of the clinical findings to determine which type of imaging to perform: whether or not you suspect osteomyelitis, [or] whether there’s the presence of an ulcer."

He recommended starting with an x-ray to see whether there is bone destruction. MRI can’t be specific for Charcot foot vs. osteomyelitis unless you consider secondary signs, said Dr. Rogers, who noted the following:

• More than 90% of cases of osteomyelitis in diabetic foot are from contiguous spread, and the spread can be traced from an ulcer to the bone on MRI.

• Osteomyelitis primarily affects only one bone, whereas Charcot may affect multiple bones.

• Deformity is more common in Charcot foot than in osteomyelitis.

• Charcot foot is more often in the midfoot, whereas osteomyelitis is more common in the toes and forefoot.

Turning to medical treatments, Dr. Rogers said, "The most important thing you can do is offloading."

He recommended educating "other members of the team," such as emergency room physicians who may treat Charcot patients presenting with an injury and a swollen foot that has not yet been x-rayed. "Offloading and immobilization can avoid the later sequelae," said Dr. Rogers.

There is little research to compare a cast walker or a total contact cast, he said. Some on the panel recommend complete avoidance of weight bearing, he said. A Roll-A-Bout walker offers another alternative.

In one study, patients took a mean of 18.5 weeks of casting to quiescence (J. Am. Podiatr. Med. Assoc. 1997;6:272-8). "This is not something where you can tell the patient, ‘We’ll have you out of the cast and walking in 3 weeks,’ " said Dr. Rogers. "You have to explain to the patient [that] this is a long process."

After taking the load off a Charcot foot, practitioners can try bisphosphonates to treat the condition, Dr. Rogers said.

The two agents that have been studied for Charcot foot are pamidronate (Aredia) and alendronate (Fosamax). Pamidromate can be given in a single 90-mg intravenous dose. (You may have to answer questions from the pharmacy because of dosing requirements for patients with renal insufficiency, but there are no dosing requirements if you are giving the dose only once, because the half-life doesn’t really matter in that case, Dr. Rogers said.) Alendronate was given in oral doses of 70 mg weekly in one study in which it was compared with pamidronate for Charcot foot, and it took longer to achieve normal foot temperature.

Another drug studied for Charcot foot is intranasal calcitonin (Miacalcin), which "might make more pathological sense," said Dr. Rogers. It is sprayed once per day in alternating nostrils. It should be given in combination with vitamin D and calcium.

How do you determine whether any of these therapies is working? By using a contact thermometer, you can compare the Charcot foot to the non-Charcot foot. A difference between the two that is greater than 4° F (2° C) is considered significant for inflammation. "Make sure this gets back to [within a] 4° difference before you put them back in their normal footwear," said Dr. Rogers.

Thermal imaging is helpful with patient compliance because it helps the patient see the difference, he said.

After getting the patient into an inactive state, make sure the foot stays protected so it doesn’t develop an ulcer, Dr. Rogers said in conclusion.

Dr. Rogers said he had no conflicts of interest to disclose.

LOS ANGELES – Practitioners treating Charcot foot have little evidence to guide them in selecting the right medicine, according to an international task force offering guidance on diagnosis and treatment of the condition.

Reporting on its January 2011 Paris meeting, task force cochair Lee C. Rogers, D.P.M., said the group of 18 experts from six countries took hours just to arrive at a definition of the syndrome. Ultimately, they decided that Charcot foot is an inflamed foot in a person with neuropathy.

The official report of the task force, convened by the American Diabetes Association (ADA) and the American Podiatric Medical Association, will be published in the journals of those organizations. Dr. Rogers of the amputation prevention center at Valley Presbyterian Hospital, Los Angeles, cautioned that he was offering only his personal observations on the proceedings.

"The major thing you’ll see in this task-force document is that there is very little evidence for any of the pharmacological treatments ... [But] that doesn’t mean we don’t use them in clinical practice," he said at the Diabetic Foot Global Conference, which was presented by Valley Presbyterian Hospital.

Although there are no good prevalence studies on Charcot foot, the task force estimated that 0.15%-1% of patients with diabetes suffer from the syndrome, said Dr. Rogers. There are 40,000 new cases a year in the United States. Patients with Charcot foot are more likely to suffer amputations, and may have a higher mortality rate, he said.

Having Charcot foot increases the risk of a foot ulcer 36 times, and 30% of patients with one Charcot foot have two Charcot feet. "It’s known that Charcot foot impacts the lifestyle of the individual, and often ... leads to permanent disability and premature retirement," Dr. Rogers said.

The syndrome appears to start with a traumatic event, which the patient may or may not remember. The trauma sparks inflammation. A patient with autonomic neuropathy may continue walking on the foot without feeling pain, leading to a cycle of fracture, subluxation, dislocation, and deformity.

"One of the things that is very important that came out of this meeting is that inflammation is the key to the pathogenesis of Charcot foot, and is also the key to diagnosis," said Dr. Rogers.

Charcot foot is often misdiagnosed, or diagnosed late. If clinicians can recognize the inflammation early on, they may be able to prevent the chain of events that leads to such conditions as rocker bottom foot later on.

The panel agreed that a Charcot foot should be classified as "active" if inflammation is continuing, or "inactive" if the inflammation has subsided. They thought this was more useful than the terms "acute" and "chronic," which only suggest how long the condition has been present.

The first step after suspecting Charcot foot is imaging, Dr. Rogers said. "What’s important when you’re trying to make a diagnosis based on imaging is that you have to incorporate a lot of the clinical findings to determine which type of imaging to perform: whether or not you suspect osteomyelitis, [or] whether there’s the presence of an ulcer."

He recommended starting with an x-ray to see whether there is bone destruction. MRI can’t be specific for Charcot foot vs. osteomyelitis unless you consider secondary signs, said Dr. Rogers, who noted the following:

• More than 90% of cases of osteomyelitis in diabetic foot are from contiguous spread, and the spread can be traced from an ulcer to the bone on MRI.

• Osteomyelitis primarily affects only one bone, whereas Charcot may affect multiple bones.

• Deformity is more common in Charcot foot than in osteomyelitis.

• Charcot foot is more often in the midfoot, whereas osteomyelitis is more common in the toes and forefoot.

Turning to medical treatments, Dr. Rogers said, "The most important thing you can do is offloading."

He recommended educating "other members of the team," such as emergency room physicians who may treat Charcot patients presenting with an injury and a swollen foot that has not yet been x-rayed. "Offloading and immobilization can avoid the later sequelae," said Dr. Rogers.

There is little research to compare a cast walker or a total contact cast, he said. Some on the panel recommend complete avoidance of weight bearing, he said. A Roll-A-Bout walker offers another alternative.

In one study, patients took a mean of 18.5 weeks of casting to quiescence (J. Am. Podiatr. Med. Assoc. 1997;6:272-8). "This is not something where you can tell the patient, ‘We’ll have you out of the cast and walking in 3 weeks,’ " said Dr. Rogers. "You have to explain to the patient [that] this is a long process."

After taking the load off a Charcot foot, practitioners can try bisphosphonates to treat the condition, Dr. Rogers said.

The two agents that have been studied for Charcot foot are pamidronate (Aredia) and alendronate (Fosamax). Pamidromate can be given in a single 90-mg intravenous dose. (You may have to answer questions from the pharmacy because of dosing requirements for patients with renal insufficiency, but there are no dosing requirements if you are giving the dose only once, because the half-life doesn’t really matter in that case, Dr. Rogers said.) Alendronate was given in oral doses of 70 mg weekly in one study in which it was compared with pamidronate for Charcot foot, and it took longer to achieve normal foot temperature.

Another drug studied for Charcot foot is intranasal calcitonin (Miacalcin), which "might make more pathological sense," said Dr. Rogers. It is sprayed once per day in alternating nostrils. It should be given in combination with vitamin D and calcium.

How do you determine whether any of these therapies is working? By using a contact thermometer, you can compare the Charcot foot to the non-Charcot foot. A difference between the two that is greater than 4° F (2° C) is considered significant for inflammation. "Make sure this gets back to [within a] 4° difference before you put them back in their normal footwear," said Dr. Rogers.

Thermal imaging is helpful with patient compliance because it helps the patient see the difference, he said.

After getting the patient into an inactive state, make sure the foot stays protected so it doesn’t develop an ulcer, Dr. Rogers said in conclusion.

Dr. Rogers said he had no conflicts of interest to disclose.

LOS ANGELES – Practitioners treating Charcot foot have little evidence to guide them in selecting the right medicine, according to an international task force offering guidance on diagnosis and treatment of the condition.

Reporting on its January 2011 Paris meeting, task force cochair Lee C. Rogers, D.P.M., said the group of 18 experts from six countries took hours just to arrive at a definition of the syndrome. Ultimately, they decided that Charcot foot is an inflamed foot in a person with neuropathy.

The official report of the task force, convened by the American Diabetes Association (ADA) and the American Podiatric Medical Association, will be published in the journals of those organizations. Dr. Rogers of the amputation prevention center at Valley Presbyterian Hospital, Los Angeles, cautioned that he was offering only his personal observations on the proceedings.

"The major thing you’ll see in this task-force document is that there is very little evidence for any of the pharmacological treatments ... [But] that doesn’t mean we don’t use them in clinical practice," he said at the Diabetic Foot Global Conference, which was presented by Valley Presbyterian Hospital.

Although there are no good prevalence studies on Charcot foot, the task force estimated that 0.15%-1% of patients with diabetes suffer from the syndrome, said Dr. Rogers. There are 40,000 new cases a year in the United States. Patients with Charcot foot are more likely to suffer amputations, and may have a higher mortality rate, he said.

Having Charcot foot increases the risk of a foot ulcer 36 times, and 30% of patients with one Charcot foot have two Charcot feet. "It’s known that Charcot foot impacts the lifestyle of the individual, and often ... leads to permanent disability and premature retirement," Dr. Rogers said.

The syndrome appears to start with a traumatic event, which the patient may or may not remember. The trauma sparks inflammation. A patient with autonomic neuropathy may continue walking on the foot without feeling pain, leading to a cycle of fracture, subluxation, dislocation, and deformity.

"One of the things that is very important that came out of this meeting is that inflammation is the key to the pathogenesis of Charcot foot, and is also the key to diagnosis," said Dr. Rogers.

Charcot foot is often misdiagnosed, or diagnosed late. If clinicians can recognize the inflammation early on, they may be able to prevent the chain of events that leads to such conditions as rocker bottom foot later on.

The panel agreed that a Charcot foot should be classified as "active" if inflammation is continuing, or "inactive" if the inflammation has subsided. They thought this was more useful than the terms "acute" and "chronic," which only suggest how long the condition has been present.

The first step after suspecting Charcot foot is imaging, Dr. Rogers said. "What’s important when you’re trying to make a diagnosis based on imaging is that you have to incorporate a lot of the clinical findings to determine which type of imaging to perform: whether or not you suspect osteomyelitis, [or] whether there’s the presence of an ulcer."

He recommended starting with an x-ray to see whether there is bone destruction. MRI can’t be specific for Charcot foot vs. osteomyelitis unless you consider secondary signs, said Dr. Rogers, who noted the following:

• More than 90% of cases of osteomyelitis in diabetic foot are from contiguous spread, and the spread can be traced from an ulcer to the bone on MRI.

• Osteomyelitis primarily affects only one bone, whereas Charcot may affect multiple bones.

• Deformity is more common in Charcot foot than in osteomyelitis.

• Charcot foot is more often in the midfoot, whereas osteomyelitis is more common in the toes and forefoot.

Turning to medical treatments, Dr. Rogers said, "The most important thing you can do is offloading."

He recommended educating "other members of the team," such as emergency room physicians who may treat Charcot patients presenting with an injury and a swollen foot that has not yet been x-rayed. "Offloading and immobilization can avoid the later sequelae," said Dr. Rogers.

There is little research to compare a cast walker or a total contact cast, he said. Some on the panel recommend complete avoidance of weight bearing, he said. A Roll-A-Bout walker offers another alternative.

In one study, patients took a mean of 18.5 weeks of casting to quiescence (J. Am. Podiatr. Med. Assoc. 1997;6:272-8). "This is not something where you can tell the patient, ‘We’ll have you out of the cast and walking in 3 weeks,’ " said Dr. Rogers. "You have to explain to the patient [that] this is a long process."

After taking the load off a Charcot foot, practitioners can try bisphosphonates to treat the condition, Dr. Rogers said.

The two agents that have been studied for Charcot foot are pamidronate (Aredia) and alendronate (Fosamax). Pamidromate can be given in a single 90-mg intravenous dose. (You may have to answer questions from the pharmacy because of dosing requirements for patients with renal insufficiency, but there are no dosing requirements if you are giving the dose only once, because the half-life doesn’t really matter in that case, Dr. Rogers said.) Alendronate was given in oral doses of 70 mg weekly in one study in which it was compared with pamidronate for Charcot foot, and it took longer to achieve normal foot temperature.

Another drug studied for Charcot foot is intranasal calcitonin (Miacalcin), which "might make more pathological sense," said Dr. Rogers. It is sprayed once per day in alternating nostrils. It should be given in combination with vitamin D and calcium.

How do you determine whether any of these therapies is working? By using a contact thermometer, you can compare the Charcot foot to the non-Charcot foot. A difference between the two that is greater than 4° F (2° C) is considered significant for inflammation. "Make sure this gets back to [within a] 4° difference before you put them back in their normal footwear," said Dr. Rogers.

Thermal imaging is helpful with patient compliance because it helps the patient see the difference, he said.

After getting the patient into an inactive state, make sure the foot stays protected so it doesn’t develop an ulcer, Dr. Rogers said in conclusion.

Dr. Rogers said he had no conflicts of interest to disclose.

LOS ANGELES – Practitioners treating Charcot foot have little evidence to guide them in selecting the right medicine, according to an international task force offering guidance on diagnosis and treatment of the condition.

Reporting on its January 2011 Paris meeting, task force cochair Lee C. Rogers, D.P.M., said the group of 18 experts from six countries took hours just to arrive at a definition of the syndrome. Ultimately, they decided that Charcot foot is an inflamed foot in a person with neuropathy.

The official report of the task force, convened by the American Diabetes Association (ADA) and the American Podiatric Medical Association, will be published in the journals of those organizations. Dr. Rogers of the amputation prevention center at Valley Presbyterian Hospital, Los Angeles, cautioned that he was offering only his personal observations on the proceedings.

"The major thing you’ll see in this task-force document is that there is very little evidence for any of the pharmacological treatments ... [But] that doesn’t mean we don’t use them in clinical practice," he said at the Diabetic Foot Global Conference, which was presented by Valley Presbyterian Hospital.

Although there are no good prevalence studies on Charcot foot, the task force estimated that 0.15%-1% of patients with diabetes suffer from the syndrome, said Dr. Rogers. There are 40,000 new cases a year in the United States. Patients with Charcot foot are more likely to suffer amputations, and may have a higher mortality rate, he said.

Having Charcot foot increases the risk of a foot ulcer 36 times, and 30% of patients with one Charcot foot have two Charcot feet. "It’s known that Charcot foot impacts the lifestyle of the individual, and often ... leads to permanent disability and premature retirement," Dr. Rogers said.

The syndrome appears to start with a traumatic event, which the patient may or may not remember. The trauma sparks inflammation. A patient with autonomic neuropathy may continue walking on the foot without feeling pain, leading to a cycle of fracture, subluxation, dislocation, and deformity.

"One of the things that is very important that came out of this meeting is that inflammation is the key to the pathogenesis of Charcot foot, and is also the key to diagnosis," said Dr. Rogers.

Charcot foot is often misdiagnosed, or diagnosed late. If clinicians can recognize the inflammation early on, they may be able to prevent the chain of events that leads to such conditions as rocker bottom foot later on.

The panel agreed that a Charcot foot should be classified as "active" if inflammation is continuing, or "inactive" if the inflammation has subsided. They thought this was more useful than the terms "acute" and "chronic," which only suggest how long the condition has been present.

The first step after suspecting Charcot foot is imaging, Dr. Rogers said. "What’s important when you’re trying to make a diagnosis based on imaging is that you have to incorporate a lot of the clinical findings to determine which type of imaging to perform: whether or not you suspect osteomyelitis, [or] whether there’s the presence of an ulcer."

He recommended starting with an x-ray to see whether there is bone destruction. MRI can’t be specific for Charcot foot vs. osteomyelitis unless you consider secondary signs, said Dr. Rogers, who noted the following:

• More than 90% of cases of osteomyelitis in diabetic foot are from contiguous spread, and the spread can be traced from an ulcer to the bone on MRI.

• Osteomyelitis primarily affects only one bone, whereas Charcot may affect multiple bones.

• Deformity is more common in Charcot foot than in osteomyelitis.

• Charcot foot is more often in the midfoot, whereas osteomyelitis is more common in the toes and forefoot.

Turning to medical treatments, Dr. Rogers said, "The most important thing you can do is offloading."

He recommended educating "other members of the team," such as emergency room physicians who may treat Charcot patients presenting with an injury and a swollen foot that has not yet been x-rayed. "Offloading and immobilization can avoid the later sequelae," said Dr. Rogers.

There is little research to compare a cast walker or a total contact cast, he said. Some on the panel recommend complete avoidance of weight bearing, he said. A Roll-A-Bout walker offers another alternative.

In one study, patients took a mean of 18.5 weeks of casting to quiescence (J. Am. Podiatr. Med. Assoc. 1997;6:272-8). "This is not something where you can tell the patient, ‘We’ll have you out of the cast and walking in 3 weeks,’ " said Dr. Rogers. "You have to explain to the patient [that] this is a long process."

After taking the load off a Charcot foot, practitioners can try bisphosphonates to treat the condition, Dr. Rogers said.

The two agents that have been studied for Charcot foot are pamidronate (Aredia) and alendronate (Fosamax). Pamidromate can be given in a single 90-mg intravenous dose. (You may have to answer questions from the pharmacy because of dosing requirements for patients with renal insufficiency, but there are no dosing requirements if you are giving the dose only once, because the half-life doesn’t really matter in that case, Dr. Rogers said.) Alendronate was given in oral doses of 70 mg weekly in one study in which it was compared with pamidronate for Charcot foot, and it took longer to achieve normal foot temperature.

Another drug studied for Charcot foot is intranasal calcitonin (Miacalcin), which "might make more pathological sense," said Dr. Rogers. It is sprayed once per day in alternating nostrils. It should be given in combination with vitamin D and calcium.

How do you determine whether any of these therapies is working? By using a contact thermometer, you can compare the Charcot foot to the non-Charcot foot. A difference between the two that is greater than 4° F (2° C) is considered significant for inflammation. "Make sure this gets back to [within a] 4° difference before you put them back in their normal footwear," said Dr. Rogers.

Thermal imaging is helpful with patient compliance because it helps the patient see the difference, he said.

After getting the patient into an inactive state, make sure the foot stays protected so it doesn’t develop an ulcer, Dr. Rogers said in conclusion.

Dr. Rogers said he had no conflicts of interest to disclose.

LOS ANGELES – Practitioners treating Charcot foot have little evidence to guide them in selecting the right medicine, according to an international task force offering guidance on diagnosis and treatment of the condition.

Reporting on its January 2011 Paris meeting, task force cochair Lee C. Rogers, D.P.M., said the group of 18 experts from six countries took hours just to arrive at a definition of the syndrome. Ultimately, they decided that Charcot foot is an inflamed foot in a person with neuropathy.

The official report of the task force, convened by the American Diabetes Association (ADA) and the American Podiatric Medical Association, will be published in the journals of those organizations. Dr. Rogers of the amputation prevention center at Valley Presbyterian Hospital, Los Angeles, cautioned that he was offering only his personal observations on the proceedings.

"The major thing you’ll see in this task-force document is that there is very little evidence for any of the pharmacological treatments ... [But] that doesn’t mean we don’t use them in clinical practice," he said at the Diabetic Foot Global Conference, which was presented by Valley Presbyterian Hospital.

Although there are no good prevalence studies on Charcot foot, the task force estimated that 0.15%-1% of patients with diabetes suffer from the syndrome, said Dr. Rogers. There are 40,000 new cases a year in the United States. Patients with Charcot foot are more likely to suffer amputations, and may have a higher mortality rate, he said.

Having Charcot foot increases the risk of a foot ulcer 36 times, and 30% of patients with one Charcot foot have two Charcot feet. "It’s known that Charcot foot impacts the lifestyle of the individual, and often ... leads to permanent disability and premature retirement," Dr. Rogers said.

The syndrome appears to start with a traumatic event, which the patient may or may not remember. The trauma sparks inflammation. A patient with autonomic neuropathy may continue walking on the foot without feeling pain, leading to a cycle of fracture, subluxation, dislocation, and deformity.

"One of the things that is very important that came out of this meeting is that inflammation is the key to the pathogenesis of Charcot foot, and is also the key to diagnosis," said Dr. Rogers.

Charcot foot is often misdiagnosed, or diagnosed late. If clinicians can recognize the inflammation early on, they may be able to prevent the chain of events that leads to such conditions as rocker bottom foot later on.

The panel agreed that a Charcot foot should be classified as "active" if inflammation is continuing, or "inactive" if the inflammation has subsided. They thought this was more useful than the terms "acute" and "chronic," which only suggest how long the condition has been present.

The first step after suspecting Charcot foot is imaging, Dr. Rogers said. "What’s important when you’re trying to make a diagnosis based on imaging is that you have to incorporate a lot of the clinical findings to determine which type of imaging to perform: whether or not you suspect osteomyelitis, [or] whether there’s the presence of an ulcer."

He recommended starting with an x-ray to see whether there is bone destruction. MRI can’t be specific for Charcot foot vs. osteomyelitis unless you consider secondary signs, said Dr. Rogers, who noted the following:

• More than 90% of cases of osteomyelitis in diabetic foot are from contiguous spread, and the spread can be traced from an ulcer to the bone on MRI.

• Osteomyelitis primarily affects only one bone, whereas Charcot may affect multiple bones.

• Deformity is more common in Charcot foot than in osteomyelitis.

• Charcot foot is more often in the midfoot, whereas osteomyelitis is more common in the toes and forefoot.

Turning to medical treatments, Dr. Rogers said, "The most important thing you can do is offloading."

He recommended educating "other members of the team," such as emergency room physicians who may treat Charcot patients presenting with an injury and a swollen foot that has not yet been x-rayed. "Offloading and immobilization can avoid the later sequelae," said Dr. Rogers.

There is little research to compare a cast walker or a total contact cast, he said. Some on the panel recommend complete avoidance of weight bearing, he said. A Roll-A-Bout walker offers another alternative.

In one study, patients took a mean of 18.5 weeks of casting to quiescence (J. Am. Podiatr. Med. Assoc. 1997;6:272-8). "This is not something where you can tell the patient, ‘We’ll have you out of the cast and walking in 3 weeks,’ " said Dr. Rogers. "You have to explain to the patient [that] this is a long process."

After taking the load off a Charcot foot, practitioners can try bisphosphonates to treat the condition, Dr. Rogers said.

The two agents that have been studied for Charcot foot are pamidronate (Aredia) and alendronate (Fosamax). Pamidromate can be given in a single 90-mg intravenous dose. (You may have to answer questions from the pharmacy because of dosing requirements for patients with renal insufficiency, but there are no dosing requirements if you are giving the dose only once, because the half-life doesn’t really matter in that case, Dr. Rogers said.) Alendronate was given in oral doses of 70 mg weekly in one study in which it was compared with pamidronate for Charcot foot, and it took longer to achieve normal foot temperature.

Another drug studied for Charcot foot is intranasal calcitonin (Miacalcin), which "might make more pathological sense," said Dr. Rogers. It is sprayed once per day in alternating nostrils. It should be given in combination with vitamin D and calcium.

How do you determine whether any of these therapies is working? By using a contact thermometer, you can compare the Charcot foot to the non-Charcot foot. A difference between the two that is greater than 4° F (2° C) is considered significant for inflammation. "Make sure this gets back to [within a] 4° difference before you put them back in their normal footwear," said Dr. Rogers.

Thermal imaging is helpful with patient compliance because it helps the patient see the difference, he said.

After getting the patient into an inactive state, make sure the foot stays protected so it doesn’t develop an ulcer, Dr. Rogers said in conclusion.

Dr. Rogers said he had no conflicts of interest to disclose.

LOS ANGELES – Practitioners treating Charcot foot have little evidence to guide them in selecting the right medicine, according to an international task force offering guidance on diagnosis and treatment of the condition.

Reporting on its January 2011 Paris meeting, task force cochair Lee C. Rogers, D.P.M., said the group of 18 experts from six countries took hours just to arrive at a definition of the syndrome. Ultimately, they decided that Charcot foot is an inflamed foot in a person with neuropathy.

The official report of the task force, convened by the American Diabetes Association (ADA) and the American Podiatric Medical Association, will be published in the journals of those organizations. Dr. Rogers of the amputation prevention center at Valley Presbyterian Hospital, Los Angeles, cautioned that he was offering only his personal observations on the proceedings.

"The major thing you’ll see in this task-force document is that there is very little evidence for any of the pharmacological treatments ... [But] that doesn’t mean we don’t use them in clinical practice," he said at the Diabetic Foot Global Conference, which was presented by Valley Presbyterian Hospital.

Although there are no good prevalence studies on Charcot foot, the task force estimated that 0.15%-1% of patients with diabetes suffer from the syndrome, said Dr. Rogers. There are 40,000 new cases a year in the United States. Patients with Charcot foot are more likely to suffer amputations, and may have a higher mortality rate, he said.

Having Charcot foot increases the risk of a foot ulcer 36 times, and 30% of patients with one Charcot foot have two Charcot feet. "It’s known that Charcot foot impacts the lifestyle of the individual, and often ... leads to permanent disability and premature retirement," Dr. Rogers said.

The syndrome appears to start with a traumatic event, which the patient may or may not remember. The trauma sparks inflammation. A patient with autonomic neuropathy may continue walking on the foot without feeling pain, leading to a cycle of fracture, subluxation, dislocation, and deformity.

"One of the things that is very important that came out of this meeting is that inflammation is the key to the pathogenesis of Charcot foot, and is also the key to diagnosis," said Dr. Rogers.

Charcot foot is often misdiagnosed, or diagnosed late. If clinicians can recognize the inflammation early on, they may be able to prevent the chain of events that leads to such conditions as rocker bottom foot later on.

The panel agreed that a Charcot foot should be classified as "active" if inflammation is continuing, or "inactive" if the inflammation has subsided. They thought this was more useful than the terms "acute" and "chronic," which only suggest how long the condition has been present.

The first step after suspecting Charcot foot is imaging, Dr. Rogers said. "What’s important when you’re trying to make a diagnosis based on imaging is that you have to incorporate a lot of the clinical findings to determine which type of imaging to perform: whether or not you suspect osteomyelitis, [or] whether there’s the presence of an ulcer."

He recommended starting with an x-ray to see whether there is bone destruction. MRI can’t be specific for Charcot foot vs. osteomyelitis unless you consider secondary signs, said Dr. Rogers, who noted the following:

• More than 90% of cases of osteomyelitis in diabetic foot are from contiguous spread, and the spread can be traced from an ulcer to the bone on MRI.

• Osteomyelitis primarily affects only one bone, whereas Charcot may affect multiple bones.

• Deformity is more common in Charcot foot than in osteomyelitis.

• Charcot foot is more often in the midfoot, whereas osteomyelitis is more common in the toes and forefoot.

Turning to medical treatments, Dr. Rogers said, "The most important thing you can do is offloading."

He recommended educating "other members of the team," such as emergency room physicians who may treat Charcot patients presenting with an injury and a swollen foot that has not yet been x-rayed. "Offloading and immobilization can avoid the later sequelae," said Dr. Rogers.

There is little research to compare a cast walker or a total contact cast, he said. Some on the panel recommend complete avoidance of weight bearing, he said. A Roll-A-Bout walker offers another alternative.

In one study, patients took a mean of 18.5 weeks of casting to quiescence (J. Am. Podiatr. Med. Assoc. 1997;6:272-8). "This is not something where you can tell the patient, ‘We’ll have you out of the cast and walking in 3 weeks,’ " said Dr. Rogers. "You have to explain to the patient [that] this is a long process."

After taking the load off a Charcot foot, practitioners can try bisphosphonates to treat the condition, Dr. Rogers said.

The two agents that have been studied for Charcot foot are pamidronate (Aredia) and alendronate (Fosamax). Pamidromate can be given in a single 90-mg intravenous dose. (You may have to answer questions from the pharmacy because of dosing requirements for patients with renal insufficiency, but there are no dosing requirements if you are giving the dose only once, because the half-life doesn’t really matter in that case, Dr. Rogers said.) Alendronate was given in oral doses of 70 mg weekly in one study in which it was compared with pamidronate for Charcot foot, and it took longer to achieve normal foot temperature.

Another drug studied for Charcot foot is intranasal calcitonin (Miacalcin), which "might make more pathological sense," said Dr. Rogers. It is sprayed once per day in alternating nostrils. It should be given in combination with vitamin D and calcium.

How do you determine whether any of these therapies is working? By using a contact thermometer, you can compare the Charcot foot to the non-Charcot foot. A difference between the two that is greater than 4° F (2° C) is considered significant for inflammation. "Make sure this gets back to [within a] 4° difference before you put them back in their normal footwear," said Dr. Rogers.

Thermal imaging is helpful with patient compliance because it helps the patient see the difference, he said.

After getting the patient into an inactive state, make sure the foot stays protected so it doesn’t develop an ulcer, Dr. Rogers said in conclusion.

Dr. Rogers said he had no conflicts of interest to disclose.

LOS ANGELES – Practitioners treating Charcot foot have little evidence to guide them in selecting the right medicine, according to an international task force offering guidance on diagnosis and treatment of the condition.

Reporting on its January 2011 Paris meeting, task force cochair Lee C. Rogers, D.P.M., said the group of 18 experts from six countries took hours just to arrive at a definition of the syndrome. Ultimately, they decided that Charcot foot is an inflamed foot in a person with neuropathy.

The official report of the task force, convened by the American Diabetes Association (ADA) and the American Podiatric Medical Association, will be published in the journals of those organizations. Dr. Rogers of the amputation prevention center at Valley Presbyterian Hospital, Los Angeles, cautioned that he was offering only his personal observations on the proceedings.

"The major thing you’ll see in this task-force document is that there is very little evidence for any of the pharmacological treatments ... [But] that doesn’t mean we don’t use them in clinical practice," he said at the Diabetic Foot Global Conference, which was presented by Valley Presbyterian Hospital.

Although there are no good prevalence studies on Charcot foot, the task force estimated that 0.15%-1% of patients with diabetes suffer from the syndrome, said Dr. Rogers. There are 40,000 new cases a year in the United States. Patients with Charcot foot are more likely to suffer amputations, and may have a higher mortality rate, he said.

Having Charcot foot increases the risk of a foot ulcer 36 times, and 30% of patients with one Charcot foot have two Charcot feet. "It’s known that Charcot foot impacts the lifestyle of the individual, and often ... leads to permanent disability and premature retirement," Dr. Rogers said.

The syndrome appears to start with a traumatic event, which the patient may or may not remember. The trauma sparks inflammation. A patient with autonomic neuropathy may continue walking on the foot without feeling pain, leading to a cycle of fracture, subluxation, dislocation, and deformity.

"One of the things that is very important that came out of this meeting is that inflammation is the key to the pathogenesis of Charcot foot, and is also the key to diagnosis," said Dr. Rogers.

Charcot foot is often misdiagnosed, or diagnosed late. If clinicians can recognize the inflammation early on, they may be able to prevent the chain of events that leads to such conditions as rocker bottom foot later on.

The panel agreed that a Charcot foot should be classified as "active" if inflammation is continuing, or "inactive" if the inflammation has subsided. They thought this was more useful than the terms "acute" and "chronic," which only suggest how long the condition has been present.

The first step after suspecting Charcot foot is imaging, Dr. Rogers said. "What’s important when you’re trying to make a diagnosis based on imaging is that you have to incorporate a lot of the clinical findings to determine which type of imaging to perform: whether or not you suspect osteomyelitis, [or] whether there’s the presence of an ulcer."

He recommended starting with an x-ray to see whether there is bone destruction. MRI can’t be specific for Charcot foot vs. osteomyelitis unless you consider secondary signs, said Dr. Rogers, who noted the following:

• More than 90% of cases of osteomyelitis in diabetic foot are from contiguous spread, and the spread can be traced from an ulcer to the bone on MRI.

• Osteomyelitis primarily affects only one bone, whereas Charcot may affect multiple bones.

• Deformity is more common in Charcot foot than in osteomyelitis.

• Charcot foot is more often in the midfoot, whereas osteomyelitis is more common in the toes and forefoot.

Turning to medical treatments, Dr. Rogers said, "The most important thing you can do is offloading."

He recommended educating "other members of the team," such as emergency room physicians who may treat Charcot patients presenting with an injury and a swollen foot that has not yet been x-rayed. "Offloading and immobilization can avoid the later sequelae," said Dr. Rogers.

There is little research to compare a cast walker or a total contact cast, he said. Some on the panel recommend complete avoidance of weight bearing, he said. A Roll-A-Bout walker offers another alternative.

In one study, patients took a mean of 18.5 weeks of casting to quiescence (J. Am. Podiatr. Med. Assoc. 1997;6:272-8). "This is not something where you can tell the patient, ‘We’ll have you out of the cast and walking in 3 weeks,’ " said Dr. Rogers. "You have to explain to the patient [that] this is a long process."

After taking the load off a Charcot foot, practitioners can try bisphosphonates to treat the condition, Dr. Rogers said.

The two agents that have been studied for Charcot foot are pamidronate (Aredia) and alendronate (Fosamax). Pamidromate can be given in a single 90-mg intravenous dose. (You may have to answer questions from the pharmacy because of dosing requirements for patients with renal insufficiency, but there are no dosing requirements if you are giving the dose only once, because the half-life doesn’t really matter in that case, Dr. Rogers said.) Alendronate was given in oral doses of 70 mg weekly in one study in which it was compared with pamidronate for Charcot foot, and it took longer to achieve normal foot temperature.

Another drug studied for Charcot foot is intranasal calcitonin (Miacalcin), which "might make more pathological sense," said Dr. Rogers. It is sprayed once per day in alternating nostrils. It should be given in combination with vitamin D and calcium.

How do you determine whether any of these therapies is working? By using a contact thermometer, you can compare the Charcot foot to the non-Charcot foot. A difference between the two that is greater than 4° F (2° C) is considered significant for inflammation. "Make sure this gets back to [within a] 4° difference before you put them back in their normal footwear," said Dr. Rogers.

Thermal imaging is helpful with patient compliance because it helps the patient see the difference, he said.

After getting the patient into an inactive state, make sure the foot stays protected so it doesn’t develop an ulcer, Dr. Rogers said in conclusion.

Dr. Rogers said he had no conflicts of interest to disclose.

LOS ANGELES – Practitioners treating Charcot foot have little evidence to guide them in selecting the right medicine, according to an international task force offering guidance on diagnosis and treatment of the condition.

Reporting on its January 2011 Paris meeting, task force cochair Lee C. Rogers, D.P.M., said the group of 18 experts from six countries took hours just to arrive at a definition of the syndrome. Ultimately, they decided that Charcot foot is an inflamed foot in a person with neuropathy.

The official report of the task force, convened by the American Diabetes Association (ADA) and the American Podiatric Medical Association, will be published in the journals of those organizations. Dr. Rogers of the amputation prevention center at Valley Presbyterian Hospital, Los Angeles, cautioned that he was offering only his personal observations on the proceedings.

"The major thing you’ll see in this task-force document is that there is very little evidence for any of the pharmacological treatments ... [But] that doesn’t mean we don’t use them in clinical practice," he said at the Diabetic Foot Global Conference, which was presented by Valley Presbyterian Hospital.

Although there are no good prevalence studies on Charcot foot, the task force estimated that 0.15%-1% of patients with diabetes suffer from the syndrome, said Dr. Rogers. There are 40,000 new cases a year in the United States. Patients with Charcot foot are more likely to suffer amputations, and may have a higher mortality rate, he said.

Having Charcot foot increases the risk of a foot ulcer 36 times, and 30% of patients with one Charcot foot have two Charcot feet. "It’s known that Charcot foot impacts the lifestyle of the individual, and often ... leads to permanent disability and premature retirement," Dr. Rogers said.

The syndrome appears to start with a traumatic event, which the patient may or may not remember. The trauma sparks inflammation. A patient with autonomic neuropathy may continue walking on the foot without feeling pain, leading to a cycle of fracture, subluxation, dislocation, and deformity.

"One of the things that is very important that came out of this meeting is that inflammation is the key to the pathogenesis of Charcot foot, and is also the key to diagnosis," said Dr. Rogers.

Charcot foot is often misdiagnosed, or diagnosed late. If clinicians can recognize the inflammation early on, they may be able to prevent the chain of events that leads to such conditions as rocker bottom foot later on.

The panel agreed that a Charcot foot should be classified as "active" if inflammation is continuing, or "inactive" if the inflammation has subsided. They thought this was more useful than the terms "acute" and "chronic," which only suggest how long the condition has been present.

The first step after suspecting Charcot foot is imaging, Dr. Rogers said. "What’s important when you’re trying to make a diagnosis based on imaging is that you have to incorporate a lot of the clinical findings to determine which type of imaging to perform: whether or not you suspect osteomyelitis, [or] whether there’s the presence of an ulcer."

He recommended starting with an x-ray to see whether there is bone destruction. MRI can’t be specific for Charcot foot vs. osteomyelitis unless you consider secondary signs, said Dr. Rogers, who noted the following:

• More than 90% of cases of osteomyelitis in diabetic foot are from contiguous spread, and the spread can be traced from an ulcer to the bone on MRI.

• Osteomyelitis primarily affects only one bone, whereas Charcot may affect multiple bones.

• Deformity is more common in Charcot foot than in osteomyelitis.

• Charcot foot is more often in the midfoot, whereas osteomyelitis is more common in the toes and forefoot.

Turning to medical treatments, Dr. Rogers said, "The most important thing you can do is offloading."

He recommended educating "other members of the team," such as emergency room physicians who may treat Charcot patients presenting with an injury and a swollen foot that has not yet been x-rayed. "Offloading and immobilization can avoid the later sequelae," said Dr. Rogers.

There is little research to compare a cast walker or a total contact cast, he said. Some on the panel recommend complete avoidance of weight bearing, he said. A Roll-A-Bout walker offers another alternative.

In one study, patients took a mean of 18.5 weeks of casting to quiescence (J. Am. Podiatr. Med. Assoc. 1997;6:272-8). "This is not something where you can tell the patient, ‘We’ll have you out of the cast and walking in 3 weeks,’ " said Dr. Rogers. "You have to explain to the patient [that] this is a long process."

After taking the load off a Charcot foot, practitioners can try bisphosphonates to treat the condition, Dr. Rogers said.

The two agents that have been studied for Charcot foot are pamidronate (Aredia) and alendronate (Fosamax). Pamidromate can be given in a single 90-mg intravenous dose. (You may have to answer questions from the pharmacy because of dosing requirements for patients with renal insufficiency, but there are no dosing requirements if you are giving the dose only once, because the half-life doesn’t really matter in that case, Dr. Rogers said.) Alendronate was given in oral doses of 70 mg weekly in one study in which it was compared with pamidronate for Charcot foot, and it took longer to achieve normal foot temperature.

Another drug studied for Charcot foot is intranasal calcitonin (Miacalcin), which "might make more pathological sense," said Dr. Rogers. It is sprayed once per day in alternating nostrils. It should be given in combination with vitamin D and calcium.

How do you determine whether any of these therapies is working? By using a contact thermometer, you can compare the Charcot foot to the non-Charcot foot. A difference between the two that is greater than 4° F (2° C) is considered significant for inflammation. "Make sure this gets back to [within a] 4° difference before you put them back in their normal footwear," said Dr. Rogers.

Thermal imaging is helpful with patient compliance because it helps the patient see the difference, he said.

After getting the patient into an inactive state, make sure the foot stays protected so it doesn’t develop an ulcer, Dr. Rogers said in conclusion.

Dr. Rogers said he had no conflicts of interest to disclose.

LOS ANGELES – New ultrasound devices have shown promise in healing wounds, according to Dr. Jonathan Rosenblum, a podiatrist at Shaare Zedek Medical Center, Jerusalem.

"In the right hands, with the right modality, it could be a sonic boom," he punned. He cautioned that "there is no good evidence yet for ultrasound for any aspect of wound care." But in his presentation at the Diabetic Foot Global Conference, he said that many encouraging cases have been reported, along with impressive laboratory research, and that he hopes to launch randomized, controlled trials soon.

Dr. Rosenblum first became interested in the technology when he tried it out on a painful venous ulcer and found that the treatment not only reduced pain but seemed to speed the healing. "With a simple saline dressing and no compression, within 10 days we went from a nasty, sloughy wound bed to a soft epithelial covering," he said at the conference, which was presented by Valley Presbyterian Hospital.

He has since tried it out on a wide variety of wounds with good success.

Researchers have experimented with ultrasound therapy using longitudinal, shear, and acoustic waves, he said. And they’ve tried high and low frequency, and high and low intensity.

Some high-frequency ultrasound devices are being used to treat pain in soft tissue, said Dr. Rosenblum. But they aren’t effective for wound care because the energy isn’t focused on the dermis, he said. "A lot of it is being wasted deeper than you need it, and you’re not getting the effect that you want."

To address that problem several years ago, inventors experimented with low-frequency devices, but these machines were too large to be commercially viable, said Dr. Rosenblum. "They took up whole rooms," he said. "These were 6-foot-tall devices."

More recently, smaller devices have been created using surface acoustic waves, a technology that is also used in some touch screens, he said. It is this technology that looks promising for wound care, said Dr. Rosenblum.

Experiments by John Loike, Ph.D., at Columbia University in New York have shown that the migration of neutrophils and epithelial cells can be significantly influenced by this type of ultrasound waves, said Dr. Rosenblum.

Other researchers have shown increased local uptake of systemic gentamicin in pseudomonas biofilms, increasing the kill rate of the antibiotic.

In addition to fighting pathogens, ultrasound may spur skin growth, said Dr. Rosenblum. "It has been shown effective in all types of collagen synthesis, including cartilage, tendon, [and] skin," he said. And it has shown capacity to reawaken senescent cells, he added.

So how can ultrasound cause these effects?

One possibility is the heat generated by the energy from the waves, said Dr. Rosenblum, which could affect various aspects of healing. For example, collagenase is sensitive to temperature.

But heat itself is probably not the whole story, he said. One other possibility is that ultrasound may stimulate cells to produce nitrous oxide. In addition to being a powerful analgesic, ultrasound is a potent vasodilator.

"We came to the conclusion that ultrasound may be beneficial to wound healing," Dr. Rosenblum concluded. "I’d like to see a couple of good studies that could change that to ‘is beneficial to wound healing.’ "

Dr. Rosenblum disclosed that he an independent consultant to NanoVibronix and a consultant to BRH Health.

LOS ANGELES – New ultrasound devices have shown promise in healing wounds, according to Dr. Jonathan Rosenblum, a podiatrist at Shaare Zedek Medical Center, Jerusalem.

"In the right hands, with the right modality, it could be a sonic boom," he punned. He cautioned that "there is no good evidence yet for ultrasound for any aspect of wound care." But in his presentation at the Diabetic Foot Global Conference, he said that many encouraging cases have been reported, along with impressive laboratory research, and that he hopes to launch randomized, controlled trials soon.

Dr. Rosenblum first became interested in the technology when he tried it out on a painful venous ulcer and found that the treatment not only reduced pain but seemed to speed the healing. "With a simple saline dressing and no compression, within 10 days we went from a nasty, sloughy wound bed to a soft epithelial covering," he said at the conference, which was presented by Valley Presbyterian Hospital.

He has since tried it out on a wide variety of wounds with good success.

Researchers have experimented with ultrasound therapy using longitudinal, shear, and acoustic waves, he said. And they’ve tried high and low frequency, and high and low intensity.

Some high-frequency ultrasound devices are being used to treat pain in soft tissue, said Dr. Rosenblum. But they aren’t effective for wound care because the energy isn’t focused on the dermis, he said. "A lot of it is being wasted deeper than you need it, and you’re not getting the effect that you want."

To address that problem several years ago, inventors experimented with low-frequency devices, but these machines were too large to be commercially viable, said Dr. Rosenblum. "They took up whole rooms," he said. "These were 6-foot-tall devices."

More recently, smaller devices have been created using surface acoustic waves, a technology that is also used in some touch screens, he said. It is this technology that looks promising for wound care, said Dr. Rosenblum.

Experiments by John Loike, Ph.D., at Columbia University in New York have shown that the migration of neutrophils and epithelial cells can be significantly influenced by this type of ultrasound waves, said Dr. Rosenblum.

Other researchers have shown increased local uptake of systemic gentamicin in pseudomonas biofilms, increasing the kill rate of the antibiotic.

In addition to fighting pathogens, ultrasound may spur skin growth, said Dr. Rosenblum. "It has been shown effective in all types of collagen synthesis, including cartilage, tendon, [and] skin," he said. And it has shown capacity to reawaken senescent cells, he added.

So how can ultrasound cause these effects?

One possibility is the heat generated by the energy from the waves, said Dr. Rosenblum, which could affect various aspects of healing. For example, collagenase is sensitive to temperature.

But heat itself is probably not the whole story, he said. One other possibility is that ultrasound may stimulate cells to produce nitrous oxide. In addition to being a powerful analgesic, ultrasound is a potent vasodilator.

"We came to the conclusion that ultrasound may be beneficial to wound healing," Dr. Rosenblum concluded. "I’d like to see a couple of good studies that could change that to ‘is beneficial to wound healing.’ "

Dr. Rosenblum disclosed that he an independent consultant to NanoVibronix and a consultant to BRH Health.

LOS ANGELES – New ultrasound devices have shown promise in healing wounds, according to Dr. Jonathan Rosenblum, a podiatrist at Shaare Zedek Medical Center, Jerusalem.

"In the right hands, with the right modality, it could be a sonic boom," he punned. He cautioned that "there is no good evidence yet for ultrasound for any aspect of wound care." But in his presentation at the Diabetic Foot Global Conference, he said that many encouraging cases have been reported, along with impressive laboratory research, and that he hopes to launch randomized, controlled trials soon.

Dr. Rosenblum first became interested in the technology when he tried it out on a painful venous ulcer and found that the treatment not only reduced pain but seemed to speed the healing. "With a simple saline dressing and no compression, within 10 days we went from a nasty, sloughy wound bed to a soft epithelial covering," he said at the conference, which was presented by Valley Presbyterian Hospital.

He has since tried it out on a wide variety of wounds with good success.

Researchers have experimented with ultrasound therapy using longitudinal, shear, and acoustic waves, he said. And they’ve tried high and low frequency, and high and low intensity.

Some high-frequency ultrasound devices are being used to treat pain in soft tissue, said Dr. Rosenblum. But they aren’t effective for wound care because the energy isn’t focused on the dermis, he said. "A lot of it is being wasted deeper than you need it, and you’re not getting the effect that you want."

To address that problem several years ago, inventors experimented with low-frequency devices, but these machines were too large to be commercially viable, said Dr. Rosenblum. "They took up whole rooms," he said. "These were 6-foot-tall devices."

More recently, smaller devices have been created using surface acoustic waves, a technology that is also used in some touch screens, he said. It is this technology that looks promising for wound care, said Dr. Rosenblum.

Experiments by John Loike, Ph.D., at Columbia University in New York have shown that the migration of neutrophils and epithelial cells can be significantly influenced by this type of ultrasound waves, said Dr. Rosenblum.

Other researchers have shown increased local uptake of systemic gentamicin in pseudomonas biofilms, increasing the kill rate of the antibiotic.

In addition to fighting pathogens, ultrasound may spur skin growth, said Dr. Rosenblum. "It has been shown effective in all types of collagen synthesis, including cartilage, tendon, [and] skin," he said. And it has shown capacity to reawaken senescent cells, he added.

So how can ultrasound cause these effects?

One possibility is the heat generated by the energy from the waves, said Dr. Rosenblum, which could affect various aspects of healing. For example, collagenase is sensitive to temperature.

But heat itself is probably not the whole story, he said. One other possibility is that ultrasound may stimulate cells to produce nitrous oxide. In addition to being a powerful analgesic, ultrasound is a potent vasodilator.

"We came to the conclusion that ultrasound may be beneficial to wound healing," Dr. Rosenblum concluded. "I’d like to see a couple of good studies that could change that to ‘is beneficial to wound healing.’ "

Dr. Rosenblum disclosed that he an independent consultant to NanoVibronix and a consultant to BRH Health.

LOS ANGELES – New ultrasound devices have shown promise in healing wounds, according to Dr. Jonathan Rosenblum, a podiatrist at Shaare Zedek Medical Center, Jerusalem.

"In the right hands, with the right modality, it could be a sonic boom," he punned. He cautioned that "there is no good evidence yet for ultrasound for any aspect of wound care." But in his presentation at the Diabetic Foot Global Conference, he said that many encouraging cases have been reported, along with impressive laboratory research, and that he hopes to launch randomized, controlled trials soon.

Dr. Rosenblum first became interested in the technology when he tried it out on a painful venous ulcer and found that the treatment not only reduced pain but seemed to speed the healing. "With a simple saline dressing and no compression, within 10 days we went from a nasty, sloughy wound bed to a soft epithelial covering," he said at the conference, which was presented by Valley Presbyterian Hospital.

He has since tried it out on a wide variety of wounds with good success.

Researchers have experimented with ultrasound therapy using longitudinal, shear, and acoustic waves, he said. And they’ve tried high and low frequency, and high and low intensity.

Some high-frequency ultrasound devices are being used to treat pain in soft tissue, said Dr. Rosenblum. But they aren’t effective for wound care because the energy isn’t focused on the dermis, he said. "A lot of it is being wasted deeper than you need it, and you’re not getting the effect that you want."

To address that problem several years ago, inventors experimented with low-frequency devices, but these machines were too large to be commercially viable, said Dr. Rosenblum. "They took up whole rooms," he said. "These were 6-foot-tall devices."

More recently, smaller devices have been created using surface acoustic waves, a technology that is also used in some touch screens, he said. It is this technology that looks promising for wound care, said Dr. Rosenblum.

Experiments by John Loike, Ph.D., at Columbia University in New York have shown that the migration of neutrophils and epithelial cells can be significantly influenced by this type of ultrasound waves, said Dr. Rosenblum.

Other researchers have shown increased local uptake of systemic gentamicin in pseudomonas biofilms, increasing the kill rate of the antibiotic.

In addition to fighting pathogens, ultrasound may spur skin growth, said Dr. Rosenblum. "It has been shown effective in all types of collagen synthesis, including cartilage, tendon, [and] skin," he said. And it has shown capacity to reawaken senescent cells, he added.

So how can ultrasound cause these effects?

One possibility is the heat generated by the energy from the waves, said Dr. Rosenblum, which could affect various aspects of healing. For example, collagenase is sensitive to temperature.

But heat itself is probably not the whole story, he said. One other possibility is that ultrasound may stimulate cells to produce nitrous oxide. In addition to being a powerful analgesic, ultrasound is a potent vasodilator.

"We came to the conclusion that ultrasound may be beneficial to wound healing," Dr. Rosenblum concluded. "I’d like to see a couple of good studies that could change that to ‘is beneficial to wound healing.’ "

Dr. Rosenblum disclosed that he an independent consultant to NanoVibronix and a consultant to BRH Health.

LOS ANGELES – New ultrasound devices have shown promise in healing wounds, according to Dr. Jonathan Rosenblum, a podiatrist at Shaare Zedek Medical Center, Jerusalem.

"In the right hands, with the right modality, it could be a sonic boom," he punned. He cautioned that "there is no good evidence yet for ultrasound for any aspect of wound care." But in his presentation at the Diabetic Foot Global Conference, he said that many encouraging cases have been reported, along with impressive laboratory research, and that he hopes to launch randomized, controlled trials soon.

Dr. Rosenblum first became interested in the technology when he tried it out on a painful venous ulcer and found that the treatment not only reduced pain but seemed to speed the healing. "With a simple saline dressing and no compression, within 10 days we went from a nasty, sloughy wound bed to a soft epithelial covering," he said at the conference, which was presented by Valley Presbyterian Hospital.

He has since tried it out on a wide variety of wounds with good success.

Researchers have experimented with ultrasound therapy using longitudinal, shear, and acoustic waves, he said. And they’ve tried high and low frequency, and high and low intensity.

Some high-frequency ultrasound devices are being used to treat pain in soft tissue, said Dr. Rosenblum. But they aren’t effective for wound care because the energy isn’t focused on the dermis, he said. "A lot of it is being wasted deeper than you need it, and you’re not getting the effect that you want."

To address that problem several years ago, inventors experimented with low-frequency devices, but these machines were too large to be commercially viable, said Dr. Rosenblum. "They took up whole rooms," he said. "These were 6-foot-tall devices."

More recently, smaller devices have been created using surface acoustic waves, a technology that is also used in some touch screens, he said. It is this technology that looks promising for wound care, said Dr. Rosenblum.

Experiments by John Loike, Ph.D., at Columbia University in New York have shown that the migration of neutrophils and epithelial cells can be significantly influenced by this type of ultrasound waves, said Dr. Rosenblum.

Other researchers have shown increased local uptake of systemic gentamicin in pseudomonas biofilms, increasing the kill rate of the antibiotic.

In addition to fighting pathogens, ultrasound may spur skin growth, said Dr. Rosenblum. "It has been shown effective in all types of collagen synthesis, including cartilage, tendon, [and] skin," he said. And it has shown capacity to reawaken senescent cells, he added.

So how can ultrasound cause these effects?

One possibility is the heat generated by the energy from the waves, said Dr. Rosenblum, which could affect various aspects of healing. For example, collagenase is sensitive to temperature.

But heat itself is probably not the whole story, he said. One other possibility is that ultrasound may stimulate cells to produce nitrous oxide. In addition to being a powerful analgesic, ultrasound is a potent vasodilator.

"We came to the conclusion that ultrasound may be beneficial to wound healing," Dr. Rosenblum concluded. "I’d like to see a couple of good studies that could change that to ‘is beneficial to wound healing.’ "

Dr. Rosenblum disclosed that he an independent consultant to NanoVibronix and a consultant to BRH Health.

LOS ANGELES – New ultrasound devices have shown promise in healing wounds, according to Dr. Jonathan Rosenblum, a podiatrist at Shaare Zedek Medical Center, Jerusalem.

"In the right hands, with the right modality, it could be a sonic boom," he punned. He cautioned that "there is no good evidence yet for ultrasound for any aspect of wound care." But in his presentation at the Diabetic Foot Global Conference, he said that many encouraging cases have been reported, along with impressive laboratory research, and that he hopes to launch randomized, controlled trials soon.

Dr. Rosenblum first became interested in the technology when he tried it out on a painful venous ulcer and found that the treatment not only reduced pain but seemed to speed the healing. "With a simple saline dressing and no compression, within 10 days we went from a nasty, sloughy wound bed to a soft epithelial covering," he said at the conference, which was presented by Valley Presbyterian Hospital.

He has since tried it out on a wide variety of wounds with good success.

Researchers have experimented with ultrasound therapy using longitudinal, shear, and acoustic waves, he said. And they’ve tried high and low frequency, and high and low intensity.

Some high-frequency ultrasound devices are being used to treat pain in soft tissue, said Dr. Rosenblum. But they aren’t effective for wound care because the energy isn’t focused on the dermis, he said. "A lot of it is being wasted deeper than you need it, and you’re not getting the effect that you want."

To address that problem several years ago, inventors experimented with low-frequency devices, but these machines were too large to be commercially viable, said Dr. Rosenblum. "They took up whole rooms," he said. "These were 6-foot-tall devices."

More recently, smaller devices have been created using surface acoustic waves, a technology that is also used in some touch screens, he said. It is this technology that looks promising for wound care, said Dr. Rosenblum.

Experiments by John Loike, Ph.D., at Columbia University in New York have shown that the migration of neutrophils and epithelial cells can be significantly influenced by this type of ultrasound waves, said Dr. Rosenblum.

Other researchers have shown increased local uptake of systemic gentamicin in pseudomonas biofilms, increasing the kill rate of the antibiotic.

In addition to fighting pathogens, ultrasound may spur skin growth, said Dr. Rosenblum. "It has been shown effective in all types of collagen synthesis, including cartilage, tendon, [and] skin," he said. And it has shown capacity to reawaken senescent cells, he added.

So how can ultrasound cause these effects?

One possibility is the heat generated by the energy from the waves, said Dr. Rosenblum, which could affect various aspects of healing. For example, collagenase is sensitive to temperature.

But heat itself is probably not the whole story, he said. One other possibility is that ultrasound may stimulate cells to produce nitrous oxide. In addition to being a powerful analgesic, ultrasound is a potent vasodilator.

"We came to the conclusion that ultrasound may be beneficial to wound healing," Dr. Rosenblum concluded. "I’d like to see a couple of good studies that could change that to ‘is beneficial to wound healing.’ "

Dr. Rosenblum disclosed that he an independent consultant to NanoVibronix and a consultant to BRH Health.

LOS ANGELES – New ultrasound devices have shown promise in healing wounds, according to Dr. Jonathan Rosenblum, a podiatrist at Shaare Zedek Medical Center, Jerusalem.

"In the right hands, with the right modality, it could be a sonic boom," he punned. He cautioned that "there is no good evidence yet for ultrasound for any aspect of wound care." But in his presentation at the Diabetic Foot Global Conference, he said that many encouraging cases have been reported, along with impressive laboratory research, and that he hopes to launch randomized, controlled trials soon.

Dr. Rosenblum first became interested in the technology when he tried it out on a painful venous ulcer and found that the treatment not only reduced pain but seemed to speed the healing. "With a simple saline dressing and no compression, within 10 days we went from a nasty, sloughy wound bed to a soft epithelial covering," he said at the conference, which was presented by Valley Presbyterian Hospital.

He has since tried it out on a wide variety of wounds with good success.

Researchers have experimented with ultrasound therapy using longitudinal, shear, and acoustic waves, he said. And they’ve tried high and low frequency, and high and low intensity.

Some high-frequency ultrasound devices are being used to treat pain in soft tissue, said Dr. Rosenblum. But they aren’t effective for wound care because the energy isn’t focused on the dermis, he said. "A lot of it is being wasted deeper than you need it, and you’re not getting the effect that you want."

To address that problem several years ago, inventors experimented with low-frequency devices, but these machines were too large to be commercially viable, said Dr. Rosenblum. "They took up whole rooms," he said. "These were 6-foot-tall devices."

More recently, smaller devices have been created using surface acoustic waves, a technology that is also used in some touch screens, he said. It is this technology that looks promising for wound care, said Dr. Rosenblum.

Experiments by John Loike, Ph.D., at Columbia University in New York have shown that the migration of neutrophils and epithelial cells can be significantly influenced by this type of ultrasound waves, said Dr. Rosenblum.

Other researchers have shown increased local uptake of systemic gentamicin in pseudomonas biofilms, increasing the kill rate of the antibiotic.

In addition to fighting pathogens, ultrasound may spur skin growth, said Dr. Rosenblum. "It has been shown effective in all types of collagen synthesis, including cartilage, tendon, [and] skin," he said. And it has shown capacity to reawaken senescent cells, he added.

So how can ultrasound cause these effects?

One possibility is the heat generated by the energy from the waves, said Dr. Rosenblum, which could affect various aspects of healing. For example, collagenase is sensitive to temperature.

But heat itself is probably not the whole story, he said. One other possibility is that ultrasound may stimulate cells to produce nitrous oxide. In addition to being a powerful analgesic, ultrasound is a potent vasodilator.

"We came to the conclusion that ultrasound may be beneficial to wound healing," Dr. Rosenblum concluded. "I’d like to see a couple of good studies that could change that to ‘is beneficial to wound healing.’ "

Dr. Rosenblum disclosed that he an independent consultant to NanoVibronix and a consultant to BRH Health.

LOS ANGELES – New ultrasound devices have shown promise in healing wounds, according to Dr. Jonathan Rosenblum, a podiatrist at Shaare Zedek Medical Center, Jerusalem.

"In the right hands, with the right modality, it could be a sonic boom," he punned. He cautioned that "there is no good evidence yet for ultrasound for any aspect of wound care." But in his presentation at the Diabetic Foot Global Conference, he said that many encouraging cases have been reported, along with impressive laboratory research, and that he hopes to launch randomized, controlled trials soon.

Dr. Rosenblum first became interested in the technology when he tried it out on a painful venous ulcer and found that the treatment not only reduced pain but seemed to speed the healing. "With a simple saline dressing and no compression, within 10 days we went from a nasty, sloughy wound bed to a soft epithelial covering," he said at the conference, which was presented by Valley Presbyterian Hospital.

He has since tried it out on a wide variety of wounds with good success.

Researchers have experimented with ultrasound therapy using longitudinal, shear, and acoustic waves, he said. And they’ve tried high and low frequency, and high and low intensity.

Some high-frequency ultrasound devices are being used to treat pain in soft tissue, said Dr. Rosenblum. But they aren’t effective for wound care because the energy isn’t focused on the dermis, he said. "A lot of it is being wasted deeper than you need it, and you’re not getting the effect that you want."

To address that problem several years ago, inventors experimented with low-frequency devices, but these machines were too large to be commercially viable, said Dr. Rosenblum. "They took up whole rooms," he said. "These were 6-foot-tall devices."

More recently, smaller devices have been created using surface acoustic waves, a technology that is also used in some touch screens, he said. It is this technology that looks promising for wound care, said Dr. Rosenblum.

Experiments by John Loike, Ph.D., at Columbia University in New York have shown that the migration of neutrophils and epithelial cells can be significantly influenced by this type of ultrasound waves, said Dr. Rosenblum.

Other researchers have shown increased local uptake of systemic gentamicin in pseudomonas biofilms, increasing the kill rate of the antibiotic.

In addition to fighting pathogens, ultrasound may spur skin growth, said Dr. Rosenblum. "It has been shown effective in all types of collagen synthesis, including cartilage, tendon, [and] skin," he said. And it has shown capacity to reawaken senescent cells, he added.

So how can ultrasound cause these effects?

One possibility is the heat generated by the energy from the waves, said Dr. Rosenblum, which could affect various aspects of healing. For example, collagenase is sensitive to temperature.

But heat itself is probably not the whole story, he said. One other possibility is that ultrasound may stimulate cells to produce nitrous oxide. In addition to being a powerful analgesic, ultrasound is a potent vasodilator.

"We came to the conclusion that ultrasound may be beneficial to wound healing," Dr. Rosenblum concluded. "I’d like to see a couple of good studies that could change that to ‘is beneficial to wound healing.’ "

Dr. Rosenblum disclosed that he an independent consultant to NanoVibronix and a consultant to BRH Health.

LOS ANGELES – New ultrasound devices have shown promise in healing wounds, according to Dr. Jonathan Rosenblum, a podiatrist at Shaare Zedek Medical Center, Jerusalem.

"In the right hands, with the right modality, it could be a sonic boom," he punned. He cautioned that "there is no good evidence yet for ultrasound for any aspect of wound care." But in his presentation at the Diabetic Foot Global Conference, he said that many encouraging cases have been reported, along with impressive laboratory research, and that he hopes to launch randomized, controlled trials soon.

Dr. Rosenblum first became interested in the technology when he tried it out on a painful venous ulcer and found that the treatment not only reduced pain but seemed to speed the healing. "With a simple saline dressing and no compression, within 10 days we went from a nasty, sloughy wound bed to a soft epithelial covering," he said at the conference, which was presented by Valley Presbyterian Hospital.

He has since tried it out on a wide variety of wounds with good success.

Researchers have experimented with ultrasound therapy using longitudinal, shear, and acoustic waves, he said. And they’ve tried high and low frequency, and high and low intensity.

Some high-frequency ultrasound devices are being used to treat pain in soft tissue, said Dr. Rosenblum. But they aren’t effective for wound care because the energy isn’t focused on the dermis, he said. "A lot of it is being wasted deeper than you need it, and you’re not getting the effect that you want."

To address that problem several years ago, inventors experimented with low-frequency devices, but these machines were too large to be commercially viable, said Dr. Rosenblum. "They took up whole rooms," he said. "These were 6-foot-tall devices."

More recently, smaller devices have been created using surface acoustic waves, a technology that is also used in some touch screens, he said. It is this technology that looks promising for wound care, said Dr. Rosenblum.

Experiments by John Loike, Ph.D., at Columbia University in New York have shown that the migration of neutrophils and epithelial cells can be significantly influenced by this type of ultrasound waves, said Dr. Rosenblum.

Other researchers have shown increased local uptake of systemic gentamicin in pseudomonas biofilms, increasing the kill rate of the antibiotic.

In addition to fighting pathogens, ultrasound may spur skin growth, said Dr. Rosenblum. "It has been shown effective in all types of collagen synthesis, including cartilage, tendon, [and] skin," he said. And it has shown capacity to reawaken senescent cells, he added.

So how can ultrasound cause these effects?

One possibility is the heat generated by the energy from the waves, said Dr. Rosenblum, which could affect various aspects of healing. For example, collagenase is sensitive to temperature.

But heat itself is probably not the whole story, he said. One other possibility is that ultrasound may stimulate cells to produce nitrous oxide. In addition to being a powerful analgesic, ultrasound is a potent vasodilator.

"We came to the conclusion that ultrasound may be beneficial to wound healing," Dr. Rosenblum concluded. "I’d like to see a couple of good studies that could change that to ‘is beneficial to wound healing.’ "

Dr. Rosenblum disclosed that he an independent consultant to NanoVibronix and a consultant to BRH Health.