HeyHippocratesAutonomic dysreflexia, spasticity, stroke recovery — a colleague who cites every call.
Clinical decision support that reasons like a physiatrist while you decide: treat autonomic dysreflexia early, ladder spasticity from the Ashworth scale to botulinum toxin, drive stroke recovery with the team, and keep back pain non-operative — with the decision rule and exactly what would change it. Built for verified physicians.
Watch it think — in rehabilitation medicine.
Two worked examples, reasoned the way it answers: the relevant clinical checks run, the answer is cited, the decision rule is explicit, and what is missing is flagged.
A patient with a T4 spinal cord injury develops a pounding headache and a blood pressure of 200/110 with flushing above the lesion — the immediate action?
This is autonomic dysreflexia, an emergency in cord injury at or above T6. Sit the patient fully upright and loosen any constrictive clothing or devices at once to drop the blood pressure. Then hunt and remove the noxious stimulus below the lesion — a distended bladder is the commonest cause, so check the catheter for kinks and drain, then look for bowel impaction and skin lesions. If the pressure stays high, give a short-acting antihypertensive such as topical nitrate or nifedipine. Untreated, it causes stroke, seizure or death.
Decision ruleAutonomic dysreflexia (SCI at or above T6, surging BP + headache + flushing above lesion) → sit upright + loosen constriction; remove the noxious stimulus (bladder first, then bowel, then skin); short-acting antihypertensive if BP stays high.
Not established from this alone — the level of injury, the trigger and the pressure response change the management.
Post-stroke spastic equinovarus foot limiting gait, modified Ashworth grade 3 — the management ladder?
Grade the tone with the modified Ashworth scale and set functional goals — gait and comfort, not just a lower number. Build the base with therapy: stretching, positioning, splinting and serial casting. For focal, disabling spasticity like this foot, botulinum toxin injection to the target muscles is first-line. Generalized spasticity calls for oral agents — baclofen or tizanidine — balanced against sedation, and severe generalized spasticity may need intrathecal baclofen. Treat only spasticity that impairs function or care.
Decision ruleGrade with modified Ashworth + functional goals → therapy base (stretch/splint/cast); focal disabling spasticity → botulinum toxin; generalized → oral baclofen/tizanidine (watch sedation); severe generalized → intrathecal baclofen; treat only function-limiting tone.
Not established from this alone — the distribution, the functional goal and the sedation tolerance change the ladder.
Illustrative simulations. The physician always decides.
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The exact questions your field searches for — answered in the format the knowledge base speaks: the answer, the decision rule, what's missing, and the source.
Stroke rehabilitation — how do I drive functional recovery?
Start rehabilitation early once the patient is medically stable, with an interdisciplinary team — physical, occupational and speech therapy, rehabilitation nursing and the physiatrist — working to shared functional goals. Deliver task-specific, high-repetition training at an adequate intensity, and match the setting, inpatient rehabilitation to outpatient, to the deficit and tolerance. Manage the complications that stall recovery: spasticity, shoulder pain, dysphagia, mood and bladder, and prevent falls and pressure injury.AHA/ASA · rehab
Decision ruleEarly rehab when stable → interdisciplinary team + shared functional goals; task-specific high-repetition training at adequate intensity; setting matched to deficit; manage spasticity/dysphagia/mood/shoulder/bladder and prevent falls and pressure injury.
Missing data: the deficits, the medical stability and the goals change the rehabilitation plan.
Autonomic dysreflexia — how do I recognize and treat it?
Suspect autonomic dysreflexia in anyone with a spinal cord injury at or above T6 who develops a sudden rise in blood pressure with a pounding headache, sweating and flushing above the lesion and often bradycardia. Sit them upright and remove constriction immediately, then systematically find and relieve the noxious trigger below the injury — first the bladder, then the bowel, then the skin. Use a rapid-onset, short-acting antihypertensive if the pressure remains dangerously high, and monitor closely afterward.PVA · SCI
Decision ruleSCI at or above T6 + sudden hypertension + headache/sweating/flushing above lesion → sit upright + loosen constriction; find and relieve the trigger (bladder → bowel → skin); short-acting antihypertensive if BP stays high; monitor.
Missing data: the injury level, the trigger and the blood-pressure response change the treatment.
Spasticity after stroke or spinal injury — the treatment ladder?
Assess with the modified Ashworth scale and anchor treatment to a functional goal, treating only spasticity that impairs movement, hygiene or comfort. The base is a therapy program of stretching, positioning, splinting and serial casting. Focal disabling spasticity responds to botulinum toxin in the target muscles; generalized spasticity to oral agents such as baclofen or tizanidine, traded off against sedation; and severe, refractory generalized spasticity to intrathecal baclofen. Reassess against the goal, not the number.PM&R · spasticity
Decision ruleModified Ashworth + functional goal → therapy base; focal → botulinum toxin; generalized → oral baclofen/tizanidine (sedation trade-off); severe refractory → intrathecal baclofen; treat only function-limiting spasticity.
Missing data: the distribution, the goal and the tolerance change the choice.
Chronic low back pain — the rehabilitation-first approach?
For non-specific chronic low back pain, lead with non-pharmacologic care: exercise, physical therapy and active rehabilitation, plus cognitive-behavioral and multidisciplinary approaches, because passive rest and prolonged imaging or opioids do more harm than good. Add non-opioid analgesia — NSAIDs or duloxetine — as needed. Reserve imaging and injections for a clear red flag or a specific structural indication, and keep opioids a last resort. Restore function rather than chase a pain score.ACP · low back pain
Decision ruleNon-specific chronic low back pain → active rehab + exercise + physical therapy first, with cognitive-behavioral/multidisciplinary care; non-opioid analgesia (NSAIDs/duloxetine) as needed; imaging/injections only for red flags or a specific indication; opioids last resort; target function.
Missing data: the red flags, the specific diagnosis and the function change the plan.
What it knows in rehabilitation medicine
Your whole practice, one specialist brain — grounded in specialist-written, cited knowledge.
A generalist physiatry colleague across stroke and brain injury, spinal cord injury, spasticity, musculoskeletal rehabilitation, amputation and pain — cited, non-directive, always with the decision rule.
Deep specialist agents for stroke and brain-injury rehabilitation, spinal cord injury, musculoskeletal and pain rehabilitation, and spasticity management — each its own specialist voice and knowledge base — plus your own uploaded materials.
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Questions physiatrists ask
It reasons in the frameworks you use — the autonomic-dysreflexia protocol, the modified Ashworth spasticity ladder, the stroke-rehabilitation principles and the low-back-pain guidance — and always shows the reasoning, the decision rule and what would change it. The decision always stays your call.
Both. Residents use it to pressure-test a plan and learn the decision rule; attendings use it as a fast, cited second opinion on the unit and in clinic. Access is gated to verified physicians.
Stroke and brain-injury rehabilitation, spinal cord injury, musculoskeletal and pain rehabilitation, and spasticity management each have their own deep specialist agent on the Pro plan, on top of the full rehabilitation-medicine scope on Basic.
No. It is physician-facing clinical decision support — a cited thinking partner. It does not diagnose, does not treat, and gives no patient-facing advice. The decision always stays with you.
Every answer is grounded only in specialist-written, cited rehabilitation-medicine knowledge — traceable to a named source — and always states the decision rule plus what data is missing, instead of a confident guess.