Rehabilitation Medical and Health News Headlines

Guest Editorial: One lesson from arthroplasty to osseointegration in search for better fixation of in-bone implanted prosthesis.

J Rehabil Res Dev. 2008;45(4):vii-xiv

Authors: Pitkin M

PMID: 18712634 [PubMed - in process]

Acute mountain sickness in disability and adaptive sports: Preliminary data.

J Rehabil Res Dev. 2008;45(4):479-88

Authors: Dicianno BE, Aguila ED, Cooper RA, Pasquina PF, Clark MJ, Collins DM, Fitzgerald SG, Wichman TA

Acute mountain sickness (AMS) is a frequent complication for military personnel, veterans, athletes, and travelers at high altitudes. Symptoms may occur in individuals with less cerebrospinal fluid volume and less ability to accommodate increased brain volume. No studies on AMS exist in individuals with neurological impairments. We studied 64 subjects, including active and sedentary controls and those with tetraplegia, paraplegia, multiple sclerosis, and traumatic brain injury at the 2007 National Veterans Winter Sports Clinic in Snowmass, Colorado. Subjects completed three Lake Louise Score surveys to quantify symptoms. We found a higher than expected occurrence of AMS overall (51.6%) but no differences among groups, and few participants sought treatment. Fatigue and weakness were common symptoms. High subject activity levels may explain these findings. More research is warranted on larger sample sizes and on preventative medications and treatments for AMS, especially since many military personnel with neurological impairments are returning to full active service.

PMID: 18712635 [PubMed - in process]

Effects of assistance dogs on persons with mobility or hearing impairments: A pilot study.

J Rehabil Res Dev. 2008;45(4):489-504

Authors: Rintala DH, Matamoros R, Seitz LL

Service dogs help persons with mobility impairments by retrieving items and performing other tasks. Hearing dogs alert persons with hearing impairments to environmental sounds. We conducted a pre-post, wait list-controlled pilot study to assess the impact of the dogs on the lives of recipients. Participants were recruited through two assistance dog training organizations and completed an initial questionnaire packet. The Experimental group completed another packet 6 months after receiving a dog. The Control group completed a second packet 6 months after the initial data collection. On average, dog recipients were very satisfied with their assistance dogs. Both service and hearing dog recipients reduced their dependence on other persons. Service dog recipients reduced hours of paid assistance. No other significant change occurred in various standardized outcome measures. Assistance dogs had a major positive impact on the lives of recipients. More appropriate measurement instruments are needed to capture the impact of these dogs.

PMID: 18712636 [PubMed - in process]

Distributed cognitive aid with scheduling and interactive task guidance.

J Rehabil Res Dev. 2008;45(4):505-22

Authors: Lopresti EF, Simpson RC, Kirsch N, Schreckenghost D, Hayashi S

A cognitive assistive technology system has been designed for use by people with memory and organizational impairments. This system will provide a distributed architecture for both scheduling assistance and task guidance, as well as intelligent, automatic replanning on the levels of both the schedule and individual tasks. A prototype of this architecture has been developed that focuses on interactive task guidance capabilities. Scheduling software has been developed but not fully integrated with the task guidance features. The system has been preliminarily tested through simulated trials, monitored use of the prototype in a clinical setting, and usability trials of the task-design interface with rehabilitation professionals. Participants were able to respond appropriately to cues provided by the system and complete prescribed tasks.

PMID: 18712637 [PubMed - in process]

Toward real-time detection of deep tissue injury risk in wheelchair users using Hertz contact theory.

J Rehabil Res Dev. 2008;45(4):537-50

Authors: Agam L, Gefen A

This study assessed the suitability of a new portable system that is based on Hertz's contact theory for evaluating internal gluteal muscle stresses under the ischial tuberosities of wheelchair users in real-time as a risk indicator for a deep tissue injury. Sitting in a wheelchair was monitored and processed with the portable system for six control subjects and five individuals with paraplegia. We compared the resultant internal peak and average muscle stresses and stress integrals over time (stress doses) of the control subjects with those of the subjects with paraplegia and validated the results against previously published subject-specific finite element (FE) stress data for the same subjects. Individuals with paraplegia were characterized by peak muscle compression stresses (mean +/- standard deviation = 109 +/- 41 kPa) that were 2.4-fold higher than in control subjects (p < 0.03). A Bland-Altman comparison indicated that stresses recorded by the present system were in satisfactory agreement with previous subject-specific magnetic resonance imaging-FE analyses. We conclude that the present stress monitoring system has the potential to be a practical means for evaluating internal muscle stresses during everyday life of individuals with paraplegia.

PMID: 18712639 [PubMed - in process]

Validation of use of wireless monitors to measure levels of mobility during hospitalization.

J Rehabil Res Dev. 2008;45(4):551-8

Authors: Brown CJ, Roth DL, Allman RM

Accurate methods of measuring levels of mobility during hospitalization are lacking. We validated the use of wireless monitors to measure three levels of mobility during hospitalization: (1) lying, (2) sitting, and (3) standing or walking. Hospitalized medical patients 65 years or older who did not have delirium or dementia and could walk in the 2 weeks before admission were eligible. Wireless monitors, which recorded average position every 20 seconds, were attached to the thigh and ankle of consented patients. Direct behavioral observation by trained observers who recorded mobility level was used as the gold standard. Forty-seven male patients (mean age 73.9 years), with a mean length of stay of 5.3 days, generated 187 two-hour direct behavioral observation periods. Wireless monitors were highly correlated with direct behavioral observations. The median kappa was 0.92 and the kappa across all observations was 0.88, indicating excellent agreement. This study demonstrates that wireless monitors validly measure mobility levels among older hospitalized patients.

PMID: 18712640 [PubMed - in process]

Evaluation of psychometric properties of Walking Impairment Questionnaire in overweight patients with osteoarthritis of knee.

J Rehabil Res Dev. 2008;45(4):559-66

Authors: Collins E, O'Connell S, Jelinek C, Miskevics S, Budiman-Mak E

This study tested the psychometric properties of the Walking Impairment Questionnaire (WIQ) in overweight patients with osteoarthritis (OA) of the knee. Internal consistency, test-retest reliability, and concurrent validity of the WIQ were measured. Used in a randomized clinical trial, the WIQ was one of the instruments completed by overweight adults with OA of the knee. A total of 105 patients completed the WIQ. Internal consistency of the WIQ was supported in this population with a Cronbach alpha total score of 0.97. Test-retest reliability scores were not different when subjects completed the WIQ 14 days apart (p > 0.05). The relationships were moderate between the WIQ subscales and other established measures, such as the 6-minute walk distance, stair climb and descend, and the Western Ontario and McMaster Universities (OA Index) questionnaire. After evaluating the psychometric properties of the WIQ, we found that it is a valid and reliable instrument to use in overweight patients with symptomatic OA of the knee.

PMID: 18712641 [PubMed - in process]

Influence of marker models on ankle kinematics in persons with partial foot amputation: An investigation using a mechanical model.

J Rehabil Res Dev. 2008;45(4):567-76

Authors: Dillon M, Hansen AH, Fatone S

Previous studies have found that ankle dorsiflexion increases in persons with partial foot amputation walking shod or in "below-ankle" devices compared with walking barefoot. However, a logical biomechanical explanation for these findings has not been offered. The purpose of this project was to determine whether marker location might explain the exaggerated dorsiflexion reported in the literature and, if so, whether more accurate data could be obtained with a different marker set. An articulated mechanical model of the shank and partial foot residuum was constructed with a potentiometer located within the mechanical ankle joint. Ankle angles measured with the calibrated potentiometer were compared with those obtained with both the Helen Hayes marker set and an alternative "residual end" marker set. Results indicated that both marker sets provided accurate and comparable measures at the metatarsophalangeal and transmetatarsal levels. At the Lisfranc level, the Helen Hayes marker set overestimated the ankle angles, primarily because of deformation of the prosthetic forefoot. These results confirm that the choice of kinematic model does influence measurements of ankle motion in persons with partial foot amputation and that the residual end marker set more accurately measures ankle motion at the Lisfranc level.

PMID: 18712642 [PubMed - in process]

Electroacupuncture may help motor recovery in chronic stroke survivors: A pilot study.

J Rehabil Res Dev. 2008;45(4):587-96

Authors: Liu W, Mukherjee M, Sun C, Liu H, McPeak LK

Past studies have suggested that acupuncture may reduce spasticity in stroke survivors. We do not know, however, whether acupuncture may enhance the effect of strength training on motor function. This study compared upper-limb motor functional improvement in chronic stroke survivors who received a combination of acupuncture and strength training with that of subjects who received strength training alone. A total of 10 chronic stroke patients with moderate or severe wrist muscle spasticity were recruited for this study. The study used a crossover design with a random order of either combined electroacupuncture and strength training or strength training alone. Each subject received one of the two types of treatment twice a week for the first 6 weeks and switched to the other for another 6 weeks. Quantitative measurements of wrist spasticity, active wrist extension range of motion, isometric wrist strength, and clinical evaluation with Fugl-Meyer (FM) upper-limb motor scores were conducted before and after either treatment. After the combined treatment, the quantitative spasticity level, active wrist extension range of motion (increased by a mean of 16.3 degrees), and FM upper-limb motor score (increased by a mean of 4.9 points) changed significantly (p < 0.01) but no significant changes were noted in isometric wrist strength. The strength training alone resulted in no significant changes to any measured variable. The results of the current study indicate that the combined acupuncture and strength training treatment reduced muscle spasticity and may have improved motor function for chronic stroke survivors with moderate or severe muscle spasticity.

PMID: 18712644 [PubMed - in process]

Prevalence and characteristics of dual sensory impairment (hearing and vision) in a veteran population.

J Rehabil Res Dev. 2008;45(4):597-610

Authors: Smith SL, Bennett LW, Wilson RH

With the increasing aging population, the number of veterans presenting with dual sensory impairment (DSI) (vision and hearing impairments) will increase. This study determined the prevalence and clinical characteristics of DSI in a veteran population receiving healthcare from the Department of Veterans Affairs (VA). A retrospective review was conducted on 400 charts randomly selected from a database of 1,472 unique veterans enrolled in the audiology and optometry outpatient clinics during a 1-year period. Depending on definition criteria, hearing impairment prevalence was 41.6% to 74.6%, vision impairment/blindness prevalence was 7.4%, and DSI prevalence was 5.0% to 7.4%. The vision impairment/blindness prevalence governed the DSI prevalence. By age, DSI prevalence ranged from 0% (among veterans <65 years) to >20% (among veterans 85+ years). The complexities encountered in defining DSI are discussed and suggestions are made for determining standardized definitions. More research is needed to determine the unique characteristics of individuals with DSI and their impact on VA resources.

PMID: 18712645 [PubMed - in process]

Accuracy of uniaxial accelerometer in chronic obstructive pulmonary disease.

J Rehabil Res Dev. 2008;45(4):611-8

Authors: Moy ML, Garshick E, Matthess KR, Lew R, Reilly JJ

Wearable sensors have been developed and used in nondisabled adults. Little is known about their accuracy in patients with chronic disease. We tested the ActiHealth accelerometer, which measures step counts, in subjects with chronic obstructive pulmonary disease (COPD). We determined the intra- and interdevice coefficients of variation (CVs). We assessed the accuracy of the device in 15 nondisabled males and 46 subjects with COPD. Accuracy was defined as percent step capture, (device step count divided by manual step count) times 100. Predictors of percent step capture were identified using linear regression methods. The accelerometer has an intradevice CV ranging from 0.008 to 0.025 and an interdevice CV of 0.64. In nondisabled males, median percent step capture was 96% (interquartile range 81%-98%). In subjects with COPD, median percent step capture was 86% (interquartile range 72%-96%). Usual walking speed was the most important predictor of percent step capture (p = 0.004). The ActiHealth accelerometer has acceptable intra- and interdevice CVs. It is highly accurate in nondisabled subjects. The accuracy declines in subjects with COPD based on walking speed. Prior to using the ActiHealth accelerometer, researchers and clinicians should assess walking speed and percent step capture in each subject.

PMID: 18712646 [PubMed - in process]

Reliability and validity of World Health Organization Quality of Life-100 in homeless substance-dependent veteran population.

J Rehabil Res Dev. 2008;45(4):619-26

Authors: Garcia-Rea E, Lepage JP

The number of homeless individuals and specifically homeless veterans is increasing. Accurate assessment of quality of life is an important need in working with this population because of the myriad problems encountered. However, the reliability and validity of quality-of-life instruments have not been assessed in this population. This study evaluated the psychometric properties of the U.S. version of the World Health Organization Quality of Life-100 in a homeless veteran population. Results found adequate internal consistency for all domain and most facet scores, while test-retest stability varied for the facet scores. We confirmed validity by using subsamples with physical, emotional, and social problems and by comparing scores from populations that returned to the community with employment and housing. Limitations and directions for future study are discussed.

PMID: 18712647 [PubMed - in process]

A 24-hour feasibility study of intraurethral valved catheter for bladder management in males with spinal cord injury.

J Rehabil Res Dev. 2008;45(4):639-46

Authors: Orris BG, Jahoda AE, Walter JS, Nemchausky BN, Wurzel R, Homan HD, Melloy S, Wheeler JS

This feasibility study was conducted to evaluate design features of the novel intraurethral valved catheter, Surinate (Urovalve, Inc; Newark, New Jersey). The device extends from the bladder neck to just beyond the external sphincter and contains a valve that can be activated by an external magnet for bladder emptying. Five patients were recruited from the Edward Hines Jr Department of Veterans Affairs Hospital spinal cord injury population. We conducted cystometry and cystoscopy to evaluate the lower urinary tract. Then, the device was inserted for 24 hours with careful monitoring. The catheter was removed from the first patient because he developed autonomic dysreflexia during implantation. The next four patients used the catheter overnight and tolerated it well: one with independent use and two with increased abdominal pressure. Emptying time was 208 +/- 99 s, residual was 42 +/- 33 mL, and the first-stream flow rate was 1.8 +/- 0.7 mL/s. The safety tether was used in three patients because the extraction device did not work. Results showed effective implantation and stability of the device in the urethra. However, objectives for use and extraction were not met. This feasibility study provided important information that will help guide design improvements for the intraurethral valved catheter.

PMID: 18712649 [PubMed - in process]