Journal of Rehabilitation Research and Development最新文献

{"title":"Metabolic effects of using a variable impedance prosthetic knee.","authors":"Matthew R Williams,&nbsp;Hugh Herr,&nbsp;Susan D'Andrea","doi":"10.1682/JRRD.2015.04.0072","DOIUrl":"https://doi.org/10.1682/JRRD.2015.04.0072","url":null,"abstract":"<p><p>A transfemoral amputation has a significant effect on walking. Though current prosthetic knee options serve to restore mobility, as do purely passive devices, they do not fully restore nondisabled gait. Persons with transfemoral amputation incur a higher metabolic cost during walking than persons without amputation and as a result walk slower and for a shorter distance before tiring. An original variable-impedance transmission prosthetic knee (VI Knee) was tested with five study participants with unilateral transfemoral amputation at two steady-state walking speeds, one below and one above their preferred walking speed. While walking with the VI Knee, participants with shorter limbs showed a reduction in metabolic cost compared with their conventional C-Leg prosthesis, while those with longer limbs exhibited an increase. Though differences were observed between speeds, overall, the difference in metabolic cost (reduction or increase) was found to correlate significantly with rise in the center of mass, with those with shorter residual limbs exhibiting less overall lifting of the body during gait.</p>","PeriodicalId":50065,"journal":{"name":"Journal of Rehabilitation Research and Development","volume":"53 6","pages":"1079-1088"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1682/JRRD.2015.04.0072","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34864755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to outcome measure administration and completion at discharge from inpatient rehabilitation of people with amputation.","authors":"Heather M MacKenzie,&nbsp;Danielle B Rice,&nbsp;C Michele Sealy,&nbsp;Peter D Cox,&nbsp;A Barry Deathe,&nbsp;Michael W C Payne","doi":"10.1682/JRRD.2015.07.0142","DOIUrl":"https://doi.org/10.1682/JRRD.2015.07.0142","url":null,"abstract":"<p><p>We performed a retrospective chart review of consecutive patients discharged from an inpatient amputee rehabilitation program over a 2 yr period (January 2010-December 2011). Our objective was to determine barriers to the completion of a standardized maximum walk test (MWT) at discharge. Over the study period, there were 190 discharges. The sample had a mean age of 63.5 yr (standard deviation [SD] +/- 14.2 yr), was 71.6% male, and had a majority of transtibial amputation (67%). The average length of inpatient stay was 28.1 d (SD +/- 13.2 d). MWT including distance and time was completed in 149 (78%) of the discharges; the main factors limiting patient performance on this measure were cardiorespiratory fatigue (53%), lower-limb pain (24%), back pain (12%), and skin problems (6%). Among those patients who completed the MWT, in 31% no limiting factor was identified. Forty-one discharge MWTs were not completed as a result of nonambulatory status (34%), acute illness (17%), limb pain (7%), skin problems (12%), or other reasons. Knowing these limitations may direct care from a clinical standpoint and provides valuable data for research planning to further examine outcome measures in this population.</p>","PeriodicalId":50065,"journal":{"name":"Journal of Rehabilitation Research and Development","volume":"53 6","pages":"1061-1068"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34866443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does comorbid chronic pain affect posttraumatic stress disorder diagnosis and treatment? Outcomes of posttraumatic stress disorder screening in Department of Veterans Affairs primary care.","authors":"Samantha D. Outcalt, H. Hoen, Zhangsheng Yu, Tenesha Marie Franks, E. Krebs","doi":"10.1682/JRRD.2014.10.0237","DOIUrl":"https://doi.org/10.1682/JRRD.2014.10.0237","url":null,"abstract":"Because posttraumatic stress disorder (PTSD) is both prevalent and underrecognized, routine primary care-based screening for PTSD has been implemented across the Veterans Health Administration. PTSD is frequently complicated by the presence of comorbid chronic pain, and patients with both conditions have increased symptom severity and poorer prognosis. Our objective was to determine whether the presence of pain affects diagnosis and treatment of PTSD among Department of Veterans Affairs (VA) patients who have a positive PTSD screening test. This retrospective cohort study used clinical and administrative data from six Midwestern VA medical centers. We identified 4,244 VA primary care patients with a positive PTSD screen and compared outcomes for those with and without a coexisting pain diagnosis. Outcomes were three clinically appropriate responses to positive PTSD screening: (1) mental health visit, (2) PTSD diagnosis, and (3) new selective serotonin reuptake inhibitor (SSRI) prescription. We found that patients with coexisting pain had a lower rate of mental health visits than those without pain (hazard ratio: 0.889, 95% confidence interval: 0.821-0.962). There were no significant differences in the rate of PTSD diagnosis or new SSRI prescription between patients with and without coexisting pain.","PeriodicalId":50065,"journal":{"name":"Journal of Rehabilitation Research and Development","volume":"53 1 1","pages":"37-44"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1682/JRRD.2014.10.0237","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67551498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Residual limb skin temperature and thermal comfort in people with amputation during activity in a cold environment.","authors":"A. Segal, G. Klute","doi":"10.1682/JRRD.2015.03.0053","DOIUrl":"https://doi.org/10.1682/JRRD.2015.03.0053","url":null,"abstract":"Thermal comfort remains a common problem for people with lower-limb amputation. Both donning a prosthesis and engaging in activity at room temperature can increase residual limb skin temperature; however, the effects of activity on skin temperature and comfort in more extreme environments remain unknown. We examined residual limb skin temperatures and perceived thermal comfort (PTC; 11-point Likert scale) of participants with unilateral transtibial amputation (n = 8) who were snowshoeing in a cold environment. Residual limb skin temperature increased by 3.9°C [3.0°C to 4.7°C] (mean difference [95% confidence interval (CI)], p < 0.001) after two 30 min exercise sessions separated by a 5 min rest session. Minimal cooling (-0.2°C [-1.1°C to 0.6°C]) occurred during the rest period. Similar changes in PTC were found for the residual limb, intact limb, and whole body, with a mean scale increase of 1.6 [1.1 to 2.1] and 1.3 [0.8 to 1.8] for the first and second exercise sessions, respectively (p < 0.001). Activity in a cold environment caused similar increases in residual limb skin temperature as those found in studies conducted at room temperature. Participants with amputation perceived warming as their skin temperature increased during exercise followed by the perception of cooling during rest, despite minimal associated decreases in skin temperature.","PeriodicalId":50065,"journal":{"name":"Journal of Rehabilitation Research and Development","volume":"53 5 1","pages":"619-628"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1682/JRRD.2015.03.0053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67552194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scoping review of mobility scooter-related research studies.","authors":"W. Mortenson, Jenny Kim","doi":"10.1682/JRRD.2015.05.0084","DOIUrl":"https://doi.org/10.1682/JRRD.2015.05.0084","url":null,"abstract":"Mobility scooters are three- or four-wheeled power mobility devices regularly used by people who have difficulty ambulating. They also differ from power wheelchairs in terms of their driving controls, programmability, seating, and mounting method. Given their growing popularity and anecdotal concerns around their use, a scoping review was undertaken to identify empirical research about mobility scooters and to analyze their study design and purpose. Data sources included MedLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, and PsychINFO. Thirty-two studies met the inclusion criteria. Most studies were descriptive in nature and reported information about scooter users' demographics, scooter-related activities, and accidents. The most common study design was a pre- and postintervention followed by a cross-sectional survey and retrospective review. Despite the increasing use of mobility scooters, surprisingly little scooter-related research has been conducted. Given the nature of most of the research in this area, further empirical evidence is needed to develop a better understanding about the frequency and causes of scooter accidents and the efficacy of interventions to improve users' skills, mobility, and safety.","PeriodicalId":50065,"journal":{"name":"Journal of Rehabilitation Research and Development","volume":"53 5 1","pages":"531-540"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1682/JRRD.2015.05.0084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67552235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of prosthetic ankle stiffness on stability of gait in people with transtibial amputation.","authors":"Matthew J Major,&nbsp;Martin Twiste,&nbsp;Laurence P J Kenney,&nbsp;David Howard","doi":"10.1682/JRRD.2015.08.0148","DOIUrl":"https://doi.org/10.1682/JRRD.2015.08.0148","url":null,"abstract":"<p><p>The ability to control balance during walking is a critical precondition for minimizing fall risk, but this ability is compromised in persons with lower-limb absence because of reduced sensory feedback mechanisms and inability to actively modulate prosthesis mechanical function. Consequently, these individuals are at increased fall risk compared with nondisabled individuals. A number of gait parameters, including symmetry and temporal variability in step/stride characteristics, have been used as estimates of gait stability and fall risk. This study investigated the effect of prosthetic ankle rotational stiffness on gait parameters related to walking stability of transtibial prosthesis users. Five men walked with an experimental prosthesis that allowed for independent modulation of plantar flexion and dorsiflexion stiffness. Two levels of plantar flexion and dorsiflexion stiffness were tested during level, uphill, and downhill walking. The results demonstrate that low plantar flexion stiffness reduced time to foot-flat, and this was associated with increased perceived stability, while low dorsiflexion stiffness demonstrated trends in temporal-spatial parameters that are associated with improved gait stability (reduced variability and asymmetry). Prosthesis design and prescription for low rotational stiffness may enhance gait safety for transtibial prosthesis users at risk of unsteadiness and falls.</p>","PeriodicalId":50065,"journal":{"name":"Journal of Rehabilitation Research and Development","volume":"53 6","pages":"839-852"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1682/JRRD.2015.08.0148","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34794544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Language treatment prior to anterior temporal lobe surgery: Can naming skills be preserved?","authors":"Diane L Kendall,&nbsp;Irene Minkina,&nbsp;Lauren Bislick,&nbsp;Thomas J Grabowski,&nbsp;Vaishali Phatak,&nbsp;JoAnn P Silkes,&nbsp;Jeffrey G Ojemann","doi":"10.1682/JRRD.2014.12.0310","DOIUrl":"https://doi.org/10.1682/JRRD.2014.12.0310","url":null,"abstract":"<p><p>Epilepsy affects 1% of the general population and is highly prevalent among Veterans. The purpose of this phase I study was to investigate a presurgical linguistically distributed language treatment program that could potentially diminish effects of proper-name retrieval deficits following left anterior temporal lobe resection for intractable epilepsy. A single-subject multiple-baseline design was employed for three individuals with late-onset chronic left temporal lobe epilepsy. Word retrieval treatment was administered prior to anterior temporal lobe resection. The primary outcome measure was confrontation naming of proper nouns. Immediately posttreatment (before surgery), there was a positive effect for all trained stimuli in the form of improved naming as compared with pretreatment. In addition, trained stimuli were found to be better after surgery than they were at pretreatment baseline, which would not be expected had language treatment not been provided. This series of case studies introduces two fundamentally novel concept: that commonly occurring deficits associated with left temporal lobe epilepsy can be treated despite the presence of damaged neural tissue and that providing this treatment prior to surgery can lead to better preservation of language function after surgery than would be expected if the treatment were not provided.</p>","PeriodicalId":50065,"journal":{"name":"Journal of Rehabilitation Research and Development","volume":"53 6","pages":"813-826"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1682/JRRD.2014.12.0310","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34794546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tongue-controlled robotic rehabilitation: A feasibility study in people with stroke.","authors":"Sarah Ostadabbas,&nbsp;Stephen N Housley,&nbsp;Nordine Sebkhi,&nbsp;Kimberly Richards,&nbsp;David Wu,&nbsp;Zhenxuan Zhang,&nbsp;Maria Garcia Rodriguez,&nbsp;Lindsey Warthen,&nbsp;Crystal Yarbrough,&nbsp;Samir Belagaje,&nbsp;Andrew J Butler,&nbsp;Maysam Ghovanloo","doi":"10.1682/JRRD.2015.06.0122","DOIUrl":"https://doi.org/10.1682/JRRD.2015.06.0122","url":null,"abstract":"<p><p>Stroke survivors with severe upper limb (UL) impairment face years of therapy to recover function. Robot-assisted therapy (RT) is increasingly used in the field for goal-oriented rehabilitation as a means to improve function in ULs. To be used effectively for wrist and hand therapy, the current RT systems require the patient to have a minimal active range of movement in the UL, and those that do not have active voluntary movement cannot use these systems. We have overcome this limitation by harnessing tongue motion to allow patients to control a robot using synchronous tongue and hand movement. This novel RT device combines a commercially available UL exoskeleton, the Hand Mentor, and our custom-designed Tongue Drive System as its controller. We conducted a proof-of-concept study on six nondisabled participants to evaluate the system usability and a case series on three participants with movement limitations from poststroke hemiparesis. Data from two stroke survivors indicate that for patients with chronic, moderate UL impairment following stroke, a 15-session training regimen resulted in modest decreases in impairment, with functional improvement and improved quality of life. The improvement met the standard of minimal clinically important difference for activities of daily living, mobility, and strength assessments.</p>","PeriodicalId":50065,"journal":{"name":"Journal of Rehabilitation Research and Development","volume":"53 6","pages":"989-1006"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1682/JRRD.2015.06.0122","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34971402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons learned in a clinical trial for military sexual trauma-related posttraumatic stress disorder.","authors":"Alina Surís,&nbsp;Nicholas Holder,&nbsp;Ryan Holliday,&nbsp;E Ellen Morris,&nbsp;Alina Surís,&nbsp;Nicholas Holder,&nbsp;Ryan Holliday,&nbsp;E Ellen Morris","doi":"10.1682/JRRD.2016.04.0064","DOIUrl":"https://doi.org/10.1682/JRRD.2016.04.0064","url":null,"abstract":"A large body of literature exists describing the challenges associated with implementing randomized controlled clinical trials (RCTs) [1]. However, when clinical trials are conducted within Department of Veterans Affairs (VA) Medical Center (VAMC) settings, several additional and unique factors contribute to the difficulty of conducting RCTs. The challenges and strategies to address them, described in this editorial, are based on an RCT conducted to determine the effectiveness of an evidence-based therapy to treat Veterans with military sexual trauma (MST)-related posttraumatic stress disorder (PTSD) [2]. Logistical and Environmental Challenges at VAMCs The number of Veterans that VAMCs serve has increased substantially since they were built [3]. Due to the design and age of many VAMCs and the increased demand for care, physical space within many VAMCs is at a premium, often necessitating updates and reorganization that require construction. Some examples of difficulties that were experienced during our study included (1) a large construction project to add needed parking spaces (temporarily reducing existing parking); (2) space issues that required frequent VAMC reorganization and changes in office locations for study therapists and personnel; (3) ongoing construction that produced frequent loud noises; and (4) due to space limitations, female Veterans with MST-related PTSD had to share small waiting rooms with male Veterans prior to study visits, often resulting in distress. Frustration and distress related to these experiences may have affected the way participants completed self-report outcome measures relating to PTSD, anger, depression, and anxiety symptoms. For example, although assessments asked participants to consider a discrete time period encompassing at a minimum the past few days, changes in current affect and anxiety can influence participants' responses [4-5]. Variability in participation could also have been affected by loud construction noise and encounters with male Veterans in small waiting rooms. These events are similar to exposure elements prominent in some therapies for PTSD, and this unintentional form of exposure could interfere with self-report accuracy. Proposed Strategies to Address Logistical and Environmental Challenges We recommend researchers anticipate logistical and environmental challenges by acquiring information about construction schedules; informing participants about construction challenges before starting the study; considering construction-related appointment delays during scheduling; and attempting to create quiet, private waiting areas. To further address space and parking limitations, reducing visits to the medical center can be helpful. For example, we encourage researchers to be flexible with follow-up data collection, such as offering phone assessments. Challenges with Documentation in the VAMC Electronic Medical Record Documentation of the diagnosis and treatment of PTSD in the electronic medical ","PeriodicalId":50065,"journal":{"name":"Journal of Rehabilitation Research and Development","volume":"53 4","pages":"vii-x"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34376146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of high-speed power training on muscle strength and power in patients with multiple sclerosis.","authors":"Carlos Medina-Perez,&nbsp;Fernanda de Souza-Teixeira,&nbsp;Rodrigo Fernandez-Gonzalo,&nbsp;Jose-Aldo Hernandez-Murua,&nbsp;Jose Antonio de Paz-Fernandez","doi":"10.1682/JRRD.2014.08.0186","DOIUrl":"https://doi.org/10.1682/JRRD.2014.08.0186","url":null,"abstract":"<p><p>This study examined the effects of a high-speed power training program in peak muscle power and maximal voluntary isometric contraction (MVIC) of knee extensors in patients with relapsing-remitting multiple sclerosis (MS). Forty patients, 20 women (age 42.8 +/- 10.3 yr) and 20 men (age 44.0 +/- 8.7 yr) diagnosed with relapsing-remitting MS were randomly assigned, with respect to sex, to either an exercise group or a control group. Participants from the exercise group performed 12 wk of supervised muscle power training of knee extensors. All subjects were tested for MVIC and peak muscle power at baseline and after the training intervention. A strain gauge was used to measure the MVIC, and peak muscle power was assessed with a linear encoder at five relative loads. The training-related effects were assessed using a t-test. The results showed no significant changes in the control group from baseline to postintervention evaluation. In contrast, the exercise group significantly increased MVIC (10.8%; p < 0.05) and muscle power at 40, 50, 60, 70, and 80% of the MVIC by 21.8, 14.5, 17.3, 19.4, and 22.3%, respectively (p < 0.01), after the training. These findings suggest that 12 wk of high-speed power training improve both MVIC and muscle power at five different loads in patients with relapsing-remitting MS.</p>","PeriodicalId":50065,"journal":{"name":"Journal of Rehabilitation Research and Development","volume":"53 3","pages":"359-68"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34445519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}