Showing papers in "Journal of Rehabilitation Research and Development in 2003"

An examination of the relationship between chronic pain and post-traumatic stress disorder.

Abstract: Chronic pain and post-traumatic stress disorder (PTSD) are frequently observed within the Department of Veterans Affairs healthcare system and are often associated with a significant level of affective distress and physical disability. Clinical practice and research suggest that these two conditions co-occur at a high rate and may interact in such a way as to negatively impact the course of either disorder; however, relatively little research has been conducted in this area. This review summarizes the current literature pertaining to the prevalence and development of chronic pain and PTSD. Research describing the comorbidity of both conditions is reviewed, and several theoretical models are presented to explain the mechanisms by which these two disorders may be maintained. Future directions for research and clinical implications are discussed.

Sensitivity to changes in disability after stroke: a comparison of four scales useful in clinical trials.

Abstract: Although most current stroke intervention trials use disability scales to determine outcome, little is known about the sensitivity to change of these scales. The use of a more sensitive measure would increase the statistical power of rehabilitation treatment trials. We applied four well-known disability scales to a group of stroke rehabilitation inpatients to compare sensitivity to change. Ninety-five consecutive admissions to a stroke rehabilitation service were assessed for disability on admission and discharge. Two global scales, the Modified Rankin Scale (MRS) and the International Stroke Trial Measure (ISTM), were compared with two activities of daily living (ADL) scales, the Barthel Index (BI) and the Functional Independence Measure (FIM). We determined the number of patients that each scale detected a clinically significant change in disability. Standardized response means (SRM) and receiver operating characteristic (ROC) analyses were performed. The MRS detected change in 55 subjects, including all who changed on the ISTM; the ISTM detected change in only 23 subjects. The BI detected change in 71 subjects but demonstrated ceiling effects with 26% of subjects scoring >95. The FIM was most sensitive, detecting change in 91 subjects; no patient achieved a maximum score. The SRM of the FIM was superior to that of the BI (2.18 versus 1.72), and ROC analysis revealed C-statistics of 0.82 for the BI, 0.59 for the MRS, and 0.51 for the ISTM. Global scales were much less sensitive to changes in disability than were ADL scales. Though ADL scales may take longer to administer, their increased sensitivity may make them more useful in treatment trials by allowing fewer subjects to be enrolled.

Bodies in motion: monitoring daily activity and exercise with motion sensors in people with chronic pulmonary disease.

Abstract: A primary goal of pulmonary rehabilitation is to improve health and life quality by encouraging participants to engage in exercise and to increase daily physical activity. The recent advent of motion sensors, including digital pedometers and accelerometers that measure motion as a continuous variable, have added precision to the measurement of free-living daily activity. Daily activity and exercise are variables of keen interest to proponents of the national health agenda, epidemiologists, clinical researchers, and rehabilitation interventionists. This paper summarizes issues related to conceptualizing and monitoring activity in the rehabilitation setting; reviews motion sensor methodology; compares motion-sensing devices; presents analysis issues and current and potential applications to the pulmonary rehabilitation setting; and gives practical applications and limitations.

Veterans' reports of pain and associations with ratings of health, health-risk behaviors, affective distress, and use of the healthcare system

Abstract: The improved management of pain among veterans seeking care in Veterans Health Administration (VHA) facilities has been established as a priority. This study documents the high prevalence of reports of pain among a convenience sample of 685 veterans seeking care in a VHA primary care setting. Also reported are associations of pain complaints with self-rated health, an index of emotional distress, health-risk behaviors such as tobacco and alcohol use, health-related concerns about diet and weight, and perceptions of the availability of social support. The relationship between the presence of pain and use of outpatient and inpatient medical and mental health services is also examined. Nearly 50% of the sample reported that they experience pain regularly and that they were concerned about this problem at the time of the index visit to their primary care provider. Persons acknowledging the presence of pain, relative to those not reporting pain, were younger, reported worsening health over the past year, had greater emotional distress, used tobacco, had diet and/or weight concerns, and were found to use more outpatient medical, but not inpatient medical or mental health services. Results support the goals of the VHA National Pain Management Strategy designed to reduce unnecessary pain and suffering among veterans receiving care in VHA facilities.

Clinical evaluation of Functional Electrical Therapy in acute hemiplegic subjects

Abstract: This paper describes a clinical randomized single-blinded study of the effects of Functional Electrical Therapy (FET) on the paretic arms of subjects with acute hemiplegia caused by strokes. FET is an exercise program that comprises voluntary arm movements and opening, closing, holding, and releasing of objects that are assisted by a neural prosthesis (electrical stimulation). FET consisted of a 30 min everyday exercise for 3 consecutive weeks in addition to conventional therapy. Twenty-eight acute hemiplegic subjects participated in a 6 mo study. The subjects were divided into lower functioning groups (LFGs) and higher functioning groups (HFGs) based on their capacity to voluntarily extend the wrist and fingers against the gravity, and were randomly assigned to controls or FET groups. The outcomes included the Upper Extremity Function Test, the coordination of elbow and shoulder movements, spasticity of key muscles of the paretic arm, and Reduced Upper Extremity Motor Activity Log. FET and control groups showed a recovery trend in all outcome measures. The gains in FET groups were much larger compared with the gains in control groups. The speed of recovery in FET groups was substantially faster compared with the recovery rate in control groups during the first 3 weeks (treatment). The LFG subjects showed less improvement than the HFG in both the FET and control groups.

Pressure ulcers in veterans with spinal cord injury: a retrospective study.

Abstract: Pressure ulcers are a major complication of spinal cord injury (SCI) and have a significant effect on general health and quality of life. The objectives of this retrospective chart review were to determine prevalence, duration, and severity of pressure ulcers in veterans with SCI and to identify predictors of (1) outcome in terms of healing without surgery, not healing, or referral for surgery; (2) number of visits veterans made to the SCI outpatient clinic or received from home care services for pressure ulcer treatment; and (3) number of hospital admissions and days hospitalized for pressure ulcer treatment. From a sampling frame of 553 veterans on the Houston Veterans Affairs Medical Center SCI roster, 215 (39%) were reported to have visited the clinic or received home care for pressure ulcers (ICD-9 code 707.0 = decubitus, any site) during the 3 years studied (1997, 1998, and 1999). From this sample, 102 veterans met the inclusion criteria for further analyses, 56% of whom had paraplegia. The duration of ulcers varied greatly from 1 week to the entire 3-year time-frame. Overall, Stage IV pressure ulcers were the most prevalent as the worst ulcer documented. Number and severity of ulcers predicted outcome and healthcare utilization. This study illustrates the magnitude of the pressure ulcer problem among veterans with SCI living in the community. Reducing the prevalence of pressure ulcers among veterans with SCI will have a significant impact on the Department of Veterans Affairs' financial and social resources. Innovative approaches are needed to reduce pressure ulcer risk in veterans with SCI.

Evaluation of an instrumented glove for hand-movement acquisition.

Abstract: Quantitative assessment of digit range of motion (ROM) is often needed for monitoring effectiveness of rehabilitative treatments and assessing patients' functional impairment. The objective of this research was to investigate the feasibility of using the Humanware Humanglove, a 20-position sensors glove, to measure fingers' ROM, with particular regard to measurement repeatability. With this aim, we performed a series of tests on six normal subjects. Data analysis was based on statistical parameters and on the intraclass correlation coefficient (ICC). Sources of errors that could affect measurement repeatability were also analyzed. The results demonstrate that, in principle, the glove could be used as goniometric device. The main advantage yielded by its use is reduction in the time needed to perform the whole measurement process, while maintaining process repeatability comparable to that achieved by traditional means of assessment. It also allows for dynamic and simultaneous recording of hand-joint movements. Future work will investigate accuracy of measurements.

Intelligent walkers for the elderly: performance and safety testing of VA-PAMAID robotic walker.

Abstract: A walker that could help navigate and avoid collisions with obstacles could help reduce health costs and increase the quality of care and independence of thousands of people. This study evaluated the safety and performance of the Veterans Affairs Personal Adaptive Mobility Aid (VA-PAMAID). We performed engineering tests on the VA-PAMAID to determine safety factors, including stability, energy consumption, fatigue life, and sensor and control malfunctions. The VA-PAMAID traveled 10.9 km on a full charge and avoided obstacles while traveling at a speed of up to 1.2 m/s. No failures occurred during static stability, climatic, or fatigue testing. Some problems were encountered during obstacle climbing and sensor and control testing. The VA-PAMAID has good range, has adequate reaction time, and is structurally sound. Clinical trials are planned to compare the device to other low-technical adaptive mobility devices.

Controlled breathing and dyspnea in patients with chronic obstructive pulmonary disease (COPD).

Abstract: Controlled breathing is included in the rehabilitation program of patients with chronic obstructive pulmonary disease (COPD). This article discusses the efficacy of controlled breathing aimed at improving dyspnea. In patients with COPD, controlled breathing works to relieve dyspnea by (1) reducing dynamic hyperinflation of the rib cage and improving gas exchange, (2) increasing strength and endurance of the respiratory muscles, and (3) optimizing the pattern of thoracoabdominal motion. Evidence of the effectiveness of controlled breathing on dyspnea is given for pursed-lips breathing, forward leaning position, and inspiratory muscle training. All interventions require careful patient selection, proper and repeated instruction, and control of the techniques and assessment of its effects. Despite the proven effectiveness of controlled breathing, several problems still need to be solved. The limited evidence of the successful transfer of controlled breathing from resting conditions to exercise conditions raises several questions: Should patients practice controlled breathing more in their daily activities? Does controlled breathing really complement the functional adaptations that patients with COPD must make? These questions need to be addressed in further research.

The globe system: an unambiguous description of shoulder positions in daily life movements.

Abstract: Positions of the shoulder joint are commonly described in terms of degrees of humeral elevation in the principal planes. This approach is inadequate for an accurate and unambiguous description of functional arm movements that are not confined to these planes. In this paper, a general unambiguous method for describing shoulder positions is adopted and visualized in globe graphs. This facilitates the use and interpretation of the method in clinical practice. To illustrate this globe system of description, a healthy subject participated in the experiments. The shoulder position is described for several functional and standardized tasks for the upper limb with three angles: (1) the angle of the plane of elevation, (2) the angle of elevation within the plane of elevation, and (3) the angle of axial rotation. With these parameters, the position of the upper arm can be visualized as a position on a “globe” about the shoulder joint. Although not perfect, the globe system provides the most unambiguous description of functional thoracohumeral positions, which is easy to apply in clinical practice.

Quantitative comparison of plantar foot shapes under different weight-bearing conditions

Abstract: Knowledge of the plantar foot shape alteration under weight bearing can offer implications for the design and construction of a comfortable and functional foot support. The purpose of this study was to quantify the change in three-dimensional foot shape under different weight-bearing conditions. The plantar foot shapes of 16 normal feet were collected by an impression casting method under three weight-bearing conditions: non-weight bearing, semi-weight bearing, and full-weight bearing. An optical digitizing system was used to capture the three-dimensional plantar surface shape of the foot cast. Measurements and comparisons from the digitized shapes were conducted for the whole foot and regions of the foot. The data showed that increased weight bearing significantly increased the contact area, foot length, foot width, and rearfoot width, while it decreased average height, arch height, and arch angle. Compared with the non-weight-bearing foot shape, the semi-weight-bearing condition would produce increases in the contact area of 35.1% +/- 21.6 %, foot length of 2.7% +/- 1.2%, foot width of 2.9% +/- 2.4%, and rearfoot width of 5.9% +/- 4.8%, and decreases in the arch height of 15.4% +/- 7.8% and arch angle of 21.7% +/- 17.2%. The full-weight-bearing condition would produce increases in the contact area of 60.4% +/- 33.2%, foot length of 3.4% +/- 1.3%, foot width of 6.0% +/- 2.1%, and rearfoot width of 8.7% +/- 4.9%, and decreases in the arch height of 20.0% +/- 9.2% and arch angle of 41.2% +/- 16.2%. The findings may be useful for considering the change of foot shape in the selection of shoe size and shoe or insole design.

Transplantation strategies to promote repair of the injured spinal cord.

Abstract: This review describes the results of the transplantation of Schwann cells and olfactory ensheathing glia in combination with other interventions. The complete transection injury model was used to test the combination of Schwann cell bridges with methylprednisolone, neurotrophins, or olfactory ensheathing glia. The contusion injury model was used to compare Schwann cell and olfactory ensheathing glia transplantation and to examine the results of combining Schwann cell transplants with elevated levels of cyclic adenosine monophosphate. The combination strategies were more effective than cell transplantation alone. The improved regeneration response usually involved a reduction in secondary tissue loss, axonal regeneration from brainstem neurons, an increase in myelinated fibers in the transplant, the exit of regenerated fibers from the transplant into the contiguous cord, and an improvement in locomotor function.

Basic gait parameters: a comparison of reference data for normal subjects 20 to 29 years of age from Kuwait and Scandinavia.

Abstract: This study obtained measurements of the spatiotemporal gait parameters of healthy young adult Kuwaiti subjects from both genders and compared the data to those collected in a similar study performed in Sweden. Thirty healthy subjects volunteered to participate in the study (which included being asked to walk at their "free," "slow," and "fast" self-selected speeds). We collected the spatiotemporal gait data using an automated system. Descriptive statistics were calculated for each variable measured at each walking condition. The data were then compared to those from the Swedish study. The results indicate several significant differences between Kuwaiti and Swedish subjects in their manner of walking. These results suggest a need to include data from subjects with diverse cultural backgrounds when a database on normal gait is developed or a need to limit the results of the database to a specified ethnic population.

Exercise training in chronic obstructive pulmonary disease.

Abstract: Exercise and activity limitation are characteristic features of chronic obstructive pulmonary disease (COPD). Exercise intolerance may result from ventilatory limitation, cardiovascular impairment, and/or skeletal muscle dysfunction. Exercise training, a core component of pulmonary rehabilitation, improves the exercise capacity (endurance and, to a lesser degree, maximal work capacity) of patients with COPD in spite of the irreversible abnormalities in lung function. Dyspnea and health-related quality of life also improve following pulmonary rehabilitation. The clinical benefits of exercise rehabilitation last up to 2 years following 8 to 12 weeks of training. Existing evidence-based guidelines recommend that exercise training/pulmonary rehabilitation be included routinely in the management of patients with moderate to severe COPD. Exercise training/ pulmonary rehabilitation may be undertaken in an inpatient, outpatient, or home-based setting, depending on the individual needs of the patient and available resources. The type and intensity of training and muscle groups trained determine the expected outcomes of exercise training. Both high- and low-intensity exercise lead to increased exercise endurance, but only high-intensity training also leads to physiologic gains in aerobic fitness. The rationale for and outcomes of lower- and upper-limb training, as well as ventilatory muscle training, are reviewed, and the potential for anabolic hormone supplementation to optimize the benefits of exercise training is discussed.

Development and validation of the Pain Outcomes Questionnaire-VA.

Abstract: The development of effective pain treatment strategies requires the availability of precise and practical measures of treatment outcomes, the importance of which has been noted in the Veterans Health Administration's (VHA's) National Pain Initiative. This paper presents the results of a 5-year collaborative effort to develop and validate a comprehensive and efficient self-report measure of pain treatment outcomes. Two samples of veterans (957 total subjects) undergoing inpatient or outpatient pain treatment at six VHA facilities completed Pain Outcomes Questionnaire-VA (POQ-VA) items and several additional measures. We used a comprehensive, multistage analytic procedure to evaluate the psychometric properties of the instrument. Results provided strong support for the reliability, validity, and clinical use of the POQ-VA when used to evaluate the effectiveness of treatment for veterans experiencing chronic noncancer pain.

Effects of regular use of neuromuscular electrical stimulation on tissue health.

Abstract: Changes in tissue health were monitored in a group of spinal cord injury (SCI) individuals with the use of an implanted neuromuscular electrical stimulation (NMES) system to provide standing and to facilitate standing transfers. Tissue health was evaluated through monitoring tissue oxygen levels in the ischial region along with measuring interface pressures at the seating support interface. Baseline assessments were done at study enrollment and repeated on completion of a conditioning exercise program. Serial assessments of tissue health were performed on eight NMES implant recipients. Unloaded tissue oxygen levels in the ischial region tended to increase after following the NMES exercise program for 8 weeks. Concurrently, pressure distributions at the seating support interface tended to change such that although the total pressure acting at the interface did not change, ischial region pressures showed a significant decrease. These changes indicate that chronic use of NMES has a quantifiable benefit on tissue health.

Critical outcomes in pulmonary rehabilitation: assessment and evaluation of dyspnea and fatigue.

Abstract: Dyspnea and fatigue, the two most common symptoms experienced by patients with chronic obstructive pulmonary disease, are believed to result in decreased activity levels and poor quality of life. The primary measurable benefits of pulmonary rehabilitation to date have been a decrease in symptoms (mainly dyspnea and fatigue) and an increase in exercise endurance. The precise means by which pulmonary rehabilitation improves these, symptoms is not clear. The use of standardized questionnaires to measure the changes associated with pulmonary rehabilitation is important if we are to understand the magnitude of improvement with the intervention and determine those who will benefit. This article reviews the mechanisms believed to contribute to these symptoms and the methods available for their measurement.

Durability of implanted electrodes and leads in an upper-limb neuroprosthesis.

Abstract: Implanted neuroprosthetic systems have been successfully used to provide upper-limb function for over 16 years. A critical aspect of these implanted systems is the safety, stability, and reliability of the stimulating electrodes and leads. These components are (1) the stimulating electrode itself, (2) the electrode lead, and (3) the lead-to-device connector. A failure in any of these components causes the direct loss of the capability to activate a muscle consistently, usually resulting in a decrement in the function provided by the neuroprosthesis. Our results indicate that the electrode, lead, and connector system are extremely durable. We analyzed 238 electrodes that have been implanted as part of an upper-limb neuroprosthesis. Each electrode had been implanted at least 3 years, with a maximum implantation time of over 16 years. Only three electrode-lead failures and one electrode infection occurred, for a survival rate of almost 99 percent. Electrode threshold measurements indicate that the electrode response is stable over time, with no evidence of electrode migration or continual encapsulation in any of the electrodes studied. These results have an impact on the design of implantable neuroprosthetic systems. The electrode-lead component of these systems should no longer be considered a weak technological link.

A word-recognition task in multitalker babble using a descending presentation mode from 24 dB to 0 dB signal to babble.

Abstract: A speech-in-multitalker-babble test instrument was developed for use in a Department of Veterans Affairs (VA) multicenter study examining the effects of hearing loss on self-perceived quality of life. Word recognition in quiet and in multitalker babble was measured on 24 listeners with normal hearing and 24 listeners with sensorineural hearing loss. The protocol involved the presentation of 10 monosyllabic words (each in a unique babble segment) at each of seven signal-to-babble (S/B) ratios from 24 dB to 0 dB, with the babble fixed at 60 dB HL (hearing loss). Word recognition in quiet at 60 dB and 80 dB HL for both groups was >90% correct. Two trials on the task were conducted. In babble, the 50% correct points were at 4.1 dB and 9.4 dB S/B for the listeners with normal hearing and hearing loss, respectively, with the 90th percentile for the listeners with normal hearing at 6 dB S/B. Twenty-two of the twenty-four listeners with hearing loss had 50% correct points outside of the 90th percentile for listeners with normal hearing. Test-retest reliability was excellent.

Long-term user perceptions of an implanted neuroprosthesis for exercise, standing, and transfers after spinal cord injury.

Abstract: This study was completed to understand the usage patterns, system performance, degree of satisfaction, complications, and health benefits as perceived by recipients of a surgically implanted neuroprosthesis for exercise, standing, and transfers in individuals with low-cervical or thoracic spinal cord injury (SCI). A standardized telephone survey was administered to 11 recipients of the Case Western Reserve University/Veterans Affairs (CWRU/VA) implanted standing neuroprosthesis with more than 12 months of experience with the functional electrical stimulation (FES) system. Nine implant recipients were using the neuroprosthesis regularly for standing and/or exercising at the time of the survey. All 11 implant recipients noted improved health and a reduced incidence of pressure sores, leg spasms, and urinary tract infections (UTIs). No incidents of deep-vein thrombosis, infection, cellulitis, or electrical burns because of the neuroprosthesis were noted. System recipients uniformly felt that the neuroprosthesis resulted in better overall health and general well-being. Subjects were moderately to very satisfied with the performance of the neuroprosthesis and unanimously expressed a willingness to repeat the surgery and rehabilitation to obtain the same clinical outcome. All implant recipients reported the system to be safe, reliable, and easy to use. The implanted standing neuroprosthesis appears to be a clinically acceptable and effective means of providing the ability to exercise, stand, and transfer to selected individuals with paraplegia or low tetraplegia.

The effect of a shock-absorbing pylon on the gait of persons with unilateral transtibial amputation.

Abstract: Shock-absorbing pylons (SAPs) are components that increase prosthetic compliance and provide shock absorption during walking, running, and other high-impact activities in persons with leg amputations. This study investigated the effect of SAPs on the gaits of persons who walk with transtibial prostheses. Two gait analyses were performed on 10 subjects walking with and without an Endolite TT (Telescopic-Torsion) Pylon. Comparison of kinematic and kinetic gait parameters indicated that few quantitative changes were found in the way people walked with and without the SAPs. The most consistent change among subjects was a reduction in the magnitude of an isolated-force transient that occurred during the prosthetic loading response phase, an effect that was more evident at higher speeds. Results from a questionnaire that was administered to subjects indicated they generally preferred walking with the SAP for reasons related to comfort. We conclude that SAPs may provide significant benefit for persons with transtibial amputations who are able to routinely walk at speeds above approximately 1.3 m/s.

Upper-limb fatigue-related joint power shifts in experienced wheelchair users and nonwheelchair users.

Abstract: This paper evaluates power transfer or shifting across upper-limb segments, resulting from fatigue-inducing wheelchair propulsion. Nineteen manual wheelchair users (WCUs) and ten nonwheelchair users (NUs) participated in this study. Subjects propelled an instrumented wheelchair ergometer at a workload corresponding to 75% of the peak oxygen uptake attained during a maximal-graded exercise tolerance test. Subjects were required to propel the wheelchair for as long as they could at a constant velocity of 3 km/h (32 rpm). The test was terminated when subjects could no longer maintain the target velocity. Peak Performance video-capture system was used to determine upper-limb kinematics. Handrim forces and joint kinematics were used to calculate joint moments and power with the use of an inverse dynamics approach. Results showed that with fatigue, joint power shifts from the shoulder joint to the elbow and wrist joints. Implications for joint injury and propulsion efficiency are discussed.

Guide to conducting tinnitus retraining therapy initial and follow-up interviews.

Abstract: Tinnitus Retraining Therapy (TRT) is a structured method of tinnitus treatment that has been performed since 1990. The TRT Initial Interview form was developed to guide clinicians in obtaining essential information from patients that would specify treatment needs. The TRT Follow-up Interview form is similar to the initial interview form and is designed to evaluate outcomes of treatment. The clinician administers these forms verbally. The forms have been used in a highly abbreviated format with the potential for inconsistent interview administration between examiners. This project was to expand the forms to provide specific wording for each question. The expanded forms are presented in this article, and the intent of each question is explained. Standardized administration of these interview forms will facilitate greater uniformity in the initial evaluation and outcomes analyses of patients treated with TRT.

The consumer's perspective and the professional literature: what do persons with spinal cord injury want?

Abstract: Different motives and purposes drive research. New knowledge advances any discipline, and use of the information obtained from careful scientific study as the basis for clinical practice promotes patient care. It is important to consider the preferences of persons with spinal cord injury (SCI) and use this as the framework in formulating research questions and clinical applications of discoveries made in the laboratory. A literature review of articles related to the interests and concerns of persons with SCI was conducted through the National Library of Medicine resource. Patient interest in finding a "cure" for SCI was not directly ascertained by any of the studies reviewed. Mobility remains the area of greatest interest, and decreased mobility has been rated as the most difficult consequence to deal with after the injury. This review indicates a congruence of the interests of both patients and researchers. However, the methodology most often used to ascertain the preferences of persons with SCI may need to be supplemented with different approaches. In addition, these preferences and the factors that influence them should be longitudinally assessed.

Psychosocial effects of an exercise program in older persons who fall.

Abstract: Falling is associated with psychosocial sequelae that may influence functional performance and fall risk. Exercise can improve psychosocial factors. To address the research questions (1) Do psychosocial variables differ among persons with and without falls? and (2) Among persons who fall, can exercise improve psychosocial variables? we evaluated psychosocial and functional performance variables in older persons with and without recent falls. A pretest and posttest design with a nonequivalent control group was used. Community-residing elderly individuals participated, 66 had falls in the past year (fallers) and 77 had no falls (nonfallers). Participants completed measures of self-esteem, depression, psychological impact, and functional performance at baseline and 6 weeks. Baseline descriptive characteristics for fallers and nonfallers were similar. Fallers then completed a 6-week exercise program. Exercise benefited fallers' self-esteem, depression, mobility, social role, social activity, and anxiety. Nearly 40% of fallers were clinically depressed before exercise and 24% were depressed after (p = 0.04). Psychosocial variables correlated significantly with quality of functional performance (p < 0.019). Among fallers, moderate exercise produced a significant improvement in psychosocial variables and functional performance (p < 0.045).

Postoperative dressing and management strategies for transtibial amputations: a critical review.

Abstract: Postamputation management is an important determinant of recovery from amputation. However, consensus on the most effective postoperative management strategies for individuals undergoing transtibial amputation (TTA) is lacking. Dressings can include simple soft gauze dressings, thigh-high rigid cast dressings, shorter removable rigid dressings, and prefabricated pneumatic dressings. Postoperative prosthetic attachments can be added to all but simple soft dressings. These dressings address the need to cleanly cover a fresh surgical wound, but not all postoperative dressings are designed to facilitate the strategic goals of preventing knee contractures, reducing edema, protecting from external trauma, or facilitating early weight bearing. The type of dressing and management strategy often overlap and are certainly interrelated. Current protocols and decisions are based on local practice, skill, and intuition. The current available literature is challenging, and difficulties include variations in healing potential, in comorbidity, in surgical-level selection, in techniques and skill, in experience with postoperative strategies, and with poorly defined outcome criteria. This paper reviews the published literature and compares measures of safety, efficacy, and clinical outcomes of the various techniques. Analysis of 10 controlled studies supported only 4 of the 14 claims cited in uncontrolled, descriptive studies.

Kinematic and dynamic performance of prosthetic knee joint using six-bar mechanism.

Abstract: Six-bar linkages have been used in some prosthetic knees in the past years, but only a few publications have been written on the special functions of the mechanism as used in transfemoral prosthesis. This paper investigates the advantages of the mechanism as used in the prosthetic knee from the kinematic and dynamic points of view. Computer simulation and an experimental method were used in the investigation. The results show that the six-bar mechanism, as compared to the four-bar mechanism, can be designed to better achieve the expected trajectory of the ankle joint in swing phase. Moreover, a six-bar linkage can be designed to have more instant inactive joints than a four-bar linkage, hence making the prosthetic knee more stable in the standing phase. In the dynamic analysis, the location of the moment controller was determined for minimum value of the control moment. A testing prosthetic knee mechanism with optimum designed parameters was manufactured for experiments in the laboratory. The experimental results have verified the advantage revealed in the analyses.

Reliability and responsiveness of elbow trajectory tracking in chronic poststroke hemiparesis.

Abstract: This study established the reliability of a novel upper-limb trajectory-tracking task for assessment of perceptual motor control in hemiparetic adults. Eleven persons with chronic poststroke hemiparesis (mean 58.6 months) and eleven nondisabled control subjects performed an elbow flexion-extension task against a low-resistance isotonic load at three speeds: 25degrees/s, 45degrees/s, and 65degrees/s. Both arms (paretic and nonparetic or dominant and nondominant) were tested during two identical sessions separated by 1 week. Relative reliability (intraclass correlation coefficient [ICC]) ranged from 0.5 to 0.8 and absolute reliability (standard error of measurement [SEM%]) ranged between 19% to 36% across both subject groups. No systematic errors between test sessions were revealed. Smallest real differences (SRDs) were determined to be +/-2degrees to 3degrees in nondisabled, +/-2degrees to 5degrees in nonparetic and +/-9degrees in paretic arms. Responsiveness ratios derived with the use of the SRDs ranged between 1.91 to 2.45, indicating that this instrument is sensitive to clinically important change and suitable for demonstrating effects on upper-limb motor performance following clinical intervention. (Less)

Psychological correlates of illusory body experiences.

Abstract: Postamputation phantom sensations and phantom pain, i.e., sensation or pain in the amputated limb, can be extremely distressing for people who have had amputations. Recent research on treating phantom phenomena has used the experimental induction of illusory body experiences. Although the suggestion has been that such experiences may influence the cortical remapping that occurs after amputation, the role of psychological factors in these experimental inductions has not been addressed. We used an able-bodied sample to investigate whether a common underlying propensity exists for illusory body experiences and whether the occurrence of these experiences is associated with previously neglected psychological variables. Psychometric measures of body plasticity, somatic preoccupation, and creative imagination were significantly and differentially associated with the occurrence of illusory body experiences. Hence, these measures have potential use in identifying patients most likely to benefit from treatment interventions using the induction of illusory body experiences.

Development of a functional assessment measure for manual wheelchair users.

Abstract: This investigation developed the Wheelchair Users Functional Assessment (WUFA). Because no functional outcome tools exist that include many of the daily activities that are needed to be independent by individuals using manual wheelchairs, development of an appropriate tool was deemed important. Although the Functional Independence Measure (FIM) can be used to assess disability in those using a wheelchair, it only measures some aspects of basic activities of daily living (ADLs) and does not measure community independence. Therefore, both basic activities and community activities were included in the new tool. A panel of six rehabilitation experts, with input from manual wheelchair users, determined content of the instrument. The resulting WUFA scale includes 13 items. Interrater reliability and stability were established with the calculation of an intraclass correlation coefficient (ICC). ICC for interrater reliability was 0.96 and ICC for stability was 0.78. Further analysis was performed on the internal consistency of the 13-item tool using a sample of 101 tested subjects. This analysis was done using a Cronbach's Alpha. Results indicated excellent internal consistency of the 13 items. The standardized coefficient alpha was 0.96. The WUFA was shown to have content validity, promising interrater reliability and stability, and good internal consistency. Further research is warranted to determine the tool's sensitivity and capability to discriminate between levels of functional independence.