Journal of Rehabilitation Research & Development tipsheet
Nighttime mobility for people with night blindness, word recognition for people with hearing loss, heath outcomes in patients poststroke
Mechanism-of-injury-based assessment and treatment improves patient care, saves money, pg 403 A mechanism-of-injury-based approach, rather than a traditional symptom-based approach, is a better way of evaluating and treating blast-injury patients, argue researchers from the James A. Haley Veterans Hospital, in Tampa, Florida. Through case examples, the authors illustrate the usefulness of the mechanism-of-injury approach in providing more comprehensive assessments and more effective treatment plans. They suggest that the mechanism-of-injury-based approach has the additional benefit of evaluating for possible secondary complications. The researchers demonstrate that the mechanism-of-injury approach is more proactive than traditional care and, therefore, potentially more efficient and cost-effective.
Reliable method to monitor voluntary movement in people with spinal cord injury, pg 413
A new method for analyzing signals from leg muscles to monitor voluntary movement is featured in this study. The voluntary response index (VRI) was tested on 69 individuals with incomplete spinal cord injury (SCI). While lying on their backs, participants completed 3 sets of 10 voluntary movements. The study was repeated by six partici- pants one week later. Data showed that the VRI is a reliable method for monitoring voluntary movement in patients with SCI. The VRI holds the potential to help clinicians detect changes in motor control that might arise after SCI rehabilitation.
Smart wheelchairs offer independent mobility to people with severe disabilities, pg 423
A summary of the state-of-the-science and future directions for research on Smart wheelchairs is presented in this study. While the needs of many individuals with disabilities can be satisfied with traditional manual or powered wheelchairs, a segment of the disabled community find it difficult or impossible to use wheelchairs independently. To accommodate this population, researchers have used technologies originally developed for mobile robots to create "smart wheelchairs." This study identified several barriers that must be overcome before smart wheelchairs can become widely used. One significant technical issue is the cost versus accuracy trade-off that must be made with existing sensors. Another is the lack of a communication standard for wheelchair input devices and motor controllers.
Body landmarks identify spinal alignment of person seated in wheelchair, pg 437
The spinal alignment of a wheelchair-seated person using front-body landmarks is identified in this study. Ten volunteers without spinal problems assumed 16 sitting positions while the thoracic and lumbar spines were examined. Data indicated that the chest and stomach lines can be used as indices for the two-dimensional alignment of the thoracic and lumbar spines when evaluating postures in a wheelchair or on a mat. Sitting posture, an important factor in special seating, may influence the development of pressure sores, as well as the comfort, function, practice, mobility, and cosmetic features of the spine.
Ground surface impacts wheelchair propulsion, pg 447
Data from a manual wheelchair propulsion study indicate that different ground surfaces impact wheelchair pro- pulsion ability, revealing conditions contributing to arm overuse in people who use wheelchairs. Eleven manual wheelchair users were fitted with a SMARTWheel and pushed on a course consisting of high- and low- pile carpet, indoor tile, interlocking concrete pavers, smooth level concrete, grass, hardwood flooring, and a sidewalk with a five-degree grade. Propulsive forces on grass, interlocking pavers, and ramp ascent were typically higher compared with tile, wood, smooth level concrete, and low- and high-pile carpeting. Users adapted to more challenging surfaces by applying more force and increasing the number of times they struck the pushrim.
Readers with low vision prefer hybrid-diffractive lenses, pg 459
More readers with macular loss prefer hybrid-diffractive lenses for prescription, according to a new study. Volunteers were assigned to groups to compare spectacle magnifiers and assess reading acuity, speed, critical print size (print size large enough to provide best fluent reading), accuracy, and comprehension. They were asked about their satisfaction with reading, comfort with reading, and cosmesis (comfort with allowing others to see them read), and which spectacle magnifier they preferred. Volunteers' reading comprehension, satisfaction, and cosmesis were significantly better with the hybrid-diffractive lens than with the refractive aspheric lens. Although critical print size was significantly better with the aplanatic lens than with the hybrid-diffractive lens, functional reading ability was not significantly different.
Wide Angle Mobility Lamp improves nightime mobility in persons with night blindness, pg 471
The Wide Angle Mobility Lamp (WAML), a low-vision mobility device used by people experiencing night blindness but few daytime travel problems, provides travel assistance more similar to that of daytime travel than the ITT Night Viewer (ITT), according to a new study. Researchers conducted engineering evaluations on both devices, including manufacturer's specifications, ergonomic characteristics, modifications, and pedestrian safety issues. Twenty-seven patients with retinitis pigmentosa gave rehabilitation evaluations on each device. Investigators found both devices improved nighttime travel for people with night blindness as compared with nighttime travel with no device. Although some participants preferred the ITT, overall most patients performed better with the WAML.
Blind rehabilitation outcomes: Evaluating patient report vs. clinician report, pg 487
Linking clinicians' ratings with patients' self-ratings following blind and low-vision rehabilitation will better assess functional improvement attained by patients suggest researchers. Investigators administered the Functional Assessment of Self-Reliance on Tasks (FAST) to nearly 200 patients at admission and at discharge to develop treatment plans and to measure blind rehabilitation efficacy. Patients completed the VA-13 at six weeks post- discharge to rate current functioning and functioning prior to blind rehabilitation training. Investigators found that the FAST reliably identifies veterans' training needs and achievements, while the VA-13 probably under- estimated patient improvement. Currently, the blind rehabilitation instruments are incompatible and need refinement to provide the most accurate measure of blind rehabilitation training.
Word-recognition assessment in noisy background, pg 499
Research shows that digit pairs or digit triplets can be used to assess the ability of older listeners with hearing loss to understand conversations in background noise. Scientists compared how well young people with normal hearing and older people with hearing loss understand digit-pairs (2, 6) and digit-triplets (3, 5, 1) when listening in a back- ground of several people talking. The background noise was at a constant volume whereas the words were presented at several volumes. For both groups, understanding the digit pairs was slightly easier than under- standing the digit triplets. Investigators conclude that two or three digits can be used equally effectively to access patients' ability to understand speech in background noise.
Ischemia training and low-resistance exercise increase muscle endurance, pg 511
A new study demonstrates that a combination of ischemic training and low-resistance exercise increases leg extension exercise endurance. Researchers examined whether repetitive, low-intensity leg extension exercise with reduced blood flow (ischemic training) increases leg extension endurance more than exercise without ischemia. Ten participants performed pre- and posttraining tests with each leg. This study shows that endurance training can be achieved with dynamic, low-intensity resistance exercise with superimposed ischemia. Ischemic training may be applied in principle to other limb movements and larger muscle groups to benefit patients with chronic diseases and limited exercise capacity.
Walking function in people with neurological disorders affected by walking speed, pg 523
Scientists have identified and isolated the effect of walking speed on patients receiving rehabilitation for a neurological disorder. This study compares gait patterns of able-bodied adults at natural speed with extremely slow overground and treadmill walking speeds. Eighteen volunteers were evaluated for trunk/lower-limb motion. Electrical activity generated from five lower-limb muscles was recorded. Investigators found significant reductions in cadence, stride, body motion, and muscle action between natural speed and slower walking speeds. The authors urge clinicians developing treatment plans for gait deficits on overground or treadmills walking to consider the effects of slower gait speed in helping patients with neurological disorders regain a normal walking pattern sooner.
Walking speed predicts health status and hospital costs for frail elderly patients, pg 535
Walking speed screening during hospital admission could help clinicians identify patients who will need the most care in the first year post-hospitalization. Baseline walking speed and change in speed over one year were used to predict health status, health service use, and costs during the same time period in 1,388 hospitalized elders identified as frail and at risk for functional decline. A reduction in baseline gait speed was associated with poorer health status and physical functioning; more disabilities, rehabilitation and medical-surgical visits, hospital days; and higher costs. Improved gait speed resulted in higher health status, improved physical function, fewer disabilities, less hospitalization, and a one-year cost reduction of $1,188.
Postural stability is a more valid measure of stability than equilibrium stability, pg 547
Postural Stability Index (PSI), a newly proposed measure of stability, is a more valid measure of stability than equilibrium score (ES) traditionally used by researchers, therapists, and physicians for assessing stability in individuals with balance problems. Study participants included 10 people with chronic fatigue syndrome, 10 veterans with medically unexplained symptoms, and 10 healthy people who completed sensory organization tests to assess their balance. Their ankle stiffness, which is generally recognized as an indicator of balance, was evaluated with PSI and ES. The results suggest that PSI is a more valid measure of balance than ES.
Study highlights proven clinical diagnostic and treatment methods for poststroke health complications, pg 557
A comprehensive review of the literature on glenohumeral subluxation (GHS) by Italian researchers advances the understanding of its role in poststroke complications and identifies effective clinical prevention and management strategies. GHS (shoulder joint dislocation) is a common complication of stroke and a risk factor for shoulder pain and other problems. Researchers found that radiographic measurements are the best method for quantifying GHS and that clinical evaluations are useful screening tools. Proven treatment strategies include functional electrical stimulation and strapping for acute hemiplegia and slings, which may be used with other strategies.
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