Brace therapy for osteoarthrisis, legal issues in TBI research, prosthetic fitting

04/28/04

Vol. 41, No. 2, Journal of Rehabilitation Research & Development

The current issue of the Journal of Rehabilitation Research and Development (JRRD) covers an array of rehabilitation research from legal and ethical issues relevant to traumatic brain injury research to patient satisfaction and use of braces in treating osteoarthritis to a new liner classification system that will improve the fit of prosthetic limbs. Abstracts from the Third International Conference on Restoration of (wheeled) Mobility in Spinal Cord Injury (SCI) Rehabilitation are available on-line only. The conference highlights research on manual wheelchair propulsion, orthotics and FES-supported gait, and mobility-related secondary health problems that will help extend treatment and prognosis of SCI rehabilitation. Full-text manuscripts are available, free of charge, on-line at www.vard.org.

MANUSCRIPTS FEATURED IN VOL. 41, NO. 2

Advance in the development of a retinal prosthesis to restore vision, pg 113
Article discusses an important step in developing a retinal prosthesis to restore vision to persons with age-related macular degeneration. Investigators studied 15 rabbit eyes to determine how quickly the retina recovers following surgical implantation of a prosthesis and stimulation of the retina. Retina responsiveness to the optic nerve declined and nerve tissue response slowed following retinal implantation and stimulation. Many of these changes lasted 90 minutes postsurgery. Failure to consider a temporary, below-normal response of the retina to surgery and stimulation could lead to a false conclusion that an implanted prosthesis is not adequately stimulating the retina.

Pitch-match range more appropriate in diagnosing tinnitus, pg 121
In this article, investigators discuss a uniform method to accurately and reliably quantify the phantom sensation of tinnitus (ringing in the ears). Forty-two volunteers with chronic tinnitus each performed three pitch-match tests: computer automated (binary and subject-guided) and traditional manual. Study results suggest that it may be more appropriate to specify the range of tinnitus pitch matches rather than a single pitch match. Further development of the automated technique will make possible a standard method to evaluate tinnitus.

Electrical stimulation inhibits bacterial growth, promises faster wound healing, pg 139
This study gives further evidence that electrical stimulation (ES) inhibits bacteria growth, enhancing wound-healing rates. Many patients with spinal cord injury, amputations, stroke, and brain injury have limited mobility that may lead to the formation of chronic pressure ulcers. Pressure-ulcer healing is often delayed by a buildup of bacteria in the wound. Investigators studied the effect of ES on bacterial growth in vitro. Four types of ES were applied to bacteria. After ES treatment, bacterial inhibition was measured. Continuous low-voltage direct and high-voltage pulsed stimulation significantly inhibited bacterial growth.

Electrical stimulation, laser treatment effective wound care therapies, pg 147
Article discusses the effects of electrical stimulation (ES) and laser treatment on wound healing in rats. One hundred and twenty-four healthy rats received ES and laser treatment to heal an induced wound. While both treatment options were beneficial in all phases of wound healing, ES was more effective than laser treatment in reducing inflammation. Combined with conventional therapies such as daily care and wound excision, ES and laser treatment are effective in pressure ulcer and chronic wound care. Wound healing studies such as this one increase our knowledge of similar conditions such as diabetic ulcers, lacerations, and burns.

Legal, ethical issues in traumatic brain injury research, pg 155
A study of federal and state laws, bioethics literature, and preliminary data from an active research project identifies and defines unresolved legal and ethical issues in traumatic brain injury (TBI) research. Areas of law impacting TBI research are advanced directives, healthcare surrogacy acts, probate acts, power of attorney acts, and the Health Insurance Portability and Accountability Act. Unclear ethical issues in research include defining vulnerability and informed consent, determining competency and decision-making capacity, and using caregivers as study participants. Investigators argue clearer regulatory guidance on research involving patients with cognitive impairments is needed.

"Liner" classification system may revolutionize prosthetic limb fitting, pg 175
A new resource has been developed to assist prosthetists in fitting. The innovation is a classification system to better match elastomeric liners (stretchy socks worn between residual limbs and prosthetic sockets) with the needs of patients with amputations. Researchers tested 15 elastomeric liners for mechanical performance. Silicone gel liners were more similar to each other than were silicone elastomer liners. Urethane liners had the highest friction with a skin-like material and the least slip. The newly-developed classification system will guide elastomeric liner prescription and fitting by providing information comparing the mechanical performance of different liner products.

Nearly 80% of people with knee arthritis satisfied with brace treatment, pg 187
In a study of brace use to treat knee arthritis, nearly 80% of patients were very satisfied or satisfied with their brace. Bracing is a treatment strategy to relieve pain, maintain function and activity level, and delay knee surgery. Forty-six patients with a minimum two-year follow-up were surveyed by phone about pain relief, function, knee surgery, and brace complications. Medical records and knee X-rays were reviewed. Of those prescribed a brace, 76% still used it at one year and 61% at three years. Younger patients were more likely to use the brace longer than older patients. Understanding brace use among patients with knee arthritis may guide future treatment options.

Easy Strutter Functional Orthosis System outperforms axillary crutches in gait test, pg 195
Study compares the performance of the Easy Strutter Functional Orthosis System (ESFOS) to axillary crutches on flat surfaces and stairs. Thirty-eight volunteers with a unilateral total knee or hip replacement were monitored for heart rate, average palm and foot force impact, and self-paced walking. ESFOS outperformed axillary crutches for comfort and stability on slippery surfaces, uneven surfaces, and stairs. ESFOS required less strength and effort during use than axillary crutches. Individuals with cardiopulmonary or musculoskeletal system impairments or reduced aerobic capacity may walk with less effort with the aid of ESFOS.

New method of evaluating posture may reduce falls in people with balance disorders, pg 207
A new method to evaluate posture control may reduce fall-related injuries in aging adults and people with balance disorders. Researchers collected balance data on healthy adults, ages 2970, to test the computational method for generating center of mass with ankle stiffness. The new computational method corrects shortcomings in an existing method for evaluating postural stability by including platform incline and ground impact. Ankle moment and ankle stiffness for standing are also evaluated. Data from this study may be used to evaluate effectiveness of rehabilitation therapies.

Pinch force may inform patients' decision on reconstructive hand surgery, pg 215
Individuals with tetraplegia (paralysis of all four limbs) may benefit from identifying pinch force requirements to accomplish daily-living tasks. Pinch force (grip between thumb and index finger) is a measure of surgical outcome for individuals with spinal cord injury (SCI). Investigators recorded pinch force and the ability to perform daily-living tasks such as opening and closing zippers, using a remote control button, and stabbing food with a fork in 14 individuals with SCI. Study data will allow surgeons to describe types of tasks patients should expect to perform after reconstructive hand surgery, informing patients' decision about surgery benefits.

Self-image, world views impact social relationships of people with schizophrenia, pg 225
Counseling focused on self-image, world perceptions may help individuals with schizophrenia form closer relationships with family and friends, say researchers. In this study, 40 patients in a postacute phase of schizophrenia completed the Attributional Style Questionnaire, the Positive and Negative Syndrome Scale, and the Quality of Life Scale. Fewer negative symptoms and the tendency to make stable attributions for life events predicted more frequent social contacts, a higher quality of social interaction, and more community participation. These findings point the way for understanding how the thoughts and feelings of people with schizophrenia affect their relationships.

New questionnaire measures impact of vision loss, evaluates rehabilitation programs, pg 233
The Department of Veterans Affairs Low Vision Visual Functioning Questionnaire (VA LV VFQ-48), a new vision function test, measures the effects of vision loss on everyday activity and evaluates visual rehabilitation effectiveness. Preliminary statistical analysis conducted after the VA LV VFQ-48 was administered to 117 study participants with vision loss indicates activities included on the questionnaire vary in difficulty from easy to hard and assess different amounts of vision loss. The VA LV VFQ-48 also measures prosthetic device effectiveness. Potentially, physicians and rehabilitation specialists could use the VA LV VFQ-48 to assess their patients' needs before entering a low-vision or blind rehabilitation program.

Source: Eurekalert & others

Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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