VA Research and Development LOGO

Logo for the Journal of Rehab R&D
Volume 41 Number 5, September/Octoberl 2004
Pages xi — xvii

An examination of the mechanisms of exercise-induced change in psychological well-being among people with spinal cord injury

Amy E. Latimer, PhD; Kathleen A. Martin Ginis, PhD; Audrey L. Hicks, PhD; Neil McCartney, PhD

Purpose of the Work. Our research has demonstrated that individuals with a spinal cord injury (SCI) who participate in twice-weekly exercise report having less pain, stress, and depression than individuals who do not exercise regularly. This study identified possible factors that caused these observed changes in pain, stress, and depression to occur. Specifically, we examined whether exercise caused (1) a decrease in pain that led to a decrease in stress and (2) a decrease in stress that led to a decrease in depression. Subjects and Procedures. This investigation included data collected from a subsample of participants who were involved in a 9-month study assessing the physiological and psychological benefits of exercise for individuals with traumatic SCI. Of the 21 participants, 11 were drawn from the twice-weekly exercise group and 10 were drawn from the nonexercise comparison group. All participants completed written questionnaires that assessed pain, stress, and depression at the 0-, 3-, 6-, and 9-month points in the study. Results. The findings suggest that the beneficial effects of exercise on stress and depression are the result of two chain reactions: exercise led to (1) a change in pain that led to a change in stress and, in turn, (2) a change in stress that led to a change in depression. Relevance to the Veteran Population. Veterans with SCI frequently report elevated levels of stress and depression. The findings from this study show health practitioners the essential intervention components necessary to increase the effectiveness of stress and depression reduction strategies for veterans. For example, a regular exercise program emphasizing pain management is recommended as a means of reducing stress. Further, an exercise program emphasizing stress management is suggested as a means of alleviating depressive symptoms.

Amy E. Latimer, PhD

Physical function in sedentary and exercising older veterans as compared to national norms

Matthew J. Peterson, MS; Gail M. Crowley, BSN, RNC; Robert J. Sullivan, MD, MPH; Miriam C. Morey, PhD

Purpose of the Work. For this study, we explored the physical function of sedentary and regularly exercising older veterans as compared to national averages. Subjects and Procedures. Forty-four participants in an outpatient exercise program for older veterans performed a 30 s timed chair stand and 6 min walk test that measured lower body strength and cardiorespiratory endurance, respectively. Test results were then compared to previously published national norms. Results. The sedentary group's chair stand and 6 min walk test scores were significantly lower (p £ 0.05) than the exercisers' scores and the national averages. The exercisers' chair stand and 6 min walk scores were not significantly different from the national averages; however, their mean 6 min walk score approached being significantly better than the national average (p = 0.095). Relevance to the Veteran Population. This study emphasized the positive associations between regular exercise and maintenance of physical functioning levels needed to successfully live independently. Older veterans can function at a level similar to an "average" older adult if they are engaged in a regular, well-rounded program of exercise. Older veterans who maintain a sedentary lifestyle should be strongly encouraged by their healthcare providers to begin exercising regularly.

Matthew J. Peterson, MS

Effect of an exercise program on functional performance of institutionalized elderly

Alessandra de Carvalho Bastone, MS, PT; Wilson Jacob Filho, PhD

Purpose of the Work. This study evaluates the effectiveness of a 6-month program of regular exercises on functional performance, mental status, and depressive symptoms in the institutionalized elderly. Subjects and Procedures. Forty subject residents in a nursing home volunteered to participate in this study and were divided either into an exercise group, those who wanted to attend the exercise sessions, or to a comparative group, those who did not want to attend the exercise sessions. Before the trial, the following variables were measured: functional performance using an obstacle course, a lower-limb functional test, and a 6-minute walk test; isometric strength of the knee extensors; proprioception of the lower limbs; mental status through the Mini-Mental State Exam (MMSE); and depression symptoms with the Geriatric Depression Scale (GDS). After the 6-month period, 19 subjects from the exercise group and 18 from the comparative group were reevaluated. Results. The exercise subjects showed significant performance improvement in the three functional tests, the knee extensors strength, and the GDS, while the comparative group showed significant decrease in the qualitative obstacle score, lower function, gait velocity, MMSE, and the GDS. Also, when we compared the means of the differences obtained by subtracting baseline from follow-up values of the exercise and comparative groups, the exercise group performed significantly better in all but the proprioception test. Relevance to the Veteran Population. This study confirms the physical and psychological benefits of exercise described in the existing literature, although studies in which the subjects are institutionalized elderly are not so easily found. It also shows the effectiveness of exercise as a form of prevention of the MMSE decline. Whether exercise affects mental health and the mechanism underlying this connection is still unclear in the literature today. Our results suggest that exercise has a positive effect in cognitive function, but to conclusively determine this issue, randomized controlled studies with large subject sample and better assessment conditions are required.

Alessandra de Carvalho Bastone, MS, PT

Visual and hearing impairment in elderly patients hospitalized for rehabilitation following hip fracture

Devora Lieberman, MD; Michael Friger, PhD; David Lieberman, MD

Purpose of the Work. The study was conducted to assess the prevalence and significance of visual and auditory impairment in patients hospitalized for rehabilitation following hip fracture. Subjects. Eight hundred and ninety-six patients were studied prospectively. Results. Visual impairment was found in 210 patients (23.4%) and auditory impairment was found in 231 patients (25.8%). Concomitant visual and auditory impairment was seen in 72 patients (8%). In univariate analysis, the absolute efficacy of rehabilitation was significantly lower in patients with visual impairment compared to those without (p = 0.00001) and in patients with auditory impairment compared to those without (p = 0.0002). However, in multivariate analysis visual (but not auditory), impairment was found to be independently associated with the absolute efficacy of rehabilitation (p = 0.001). Relevance to the Veteran Population. In light of these results, we propose that in the first phase of rehabilitation, patients' visual acuity needs to be optimized.

Devora Lieberman, MD

Biomechanical and clinical evaluation of a newly designed polycentric knee of transfemoral prosthesis

Kazutoshi Yokogushi, PhD; Hiroshi Narita, PhD; Eiichi Uchiyama, PhD; Susumu Chiba, PhD; Toshiya Nosaka, PhD; Ken-ichi Yamakoshi, Prof PhD

Purpose of the Work. Various types of microprocessor-controlled transfemoral prostheses are now available. Although a lot of advertising appears in the media for the polycentric knee, little clinical and biomechanical data can be found in the literature. We have designed a new polycentric knee. This prototype consists of a hydraulic unit, which works during the stance phase, and an air pressure unit controlled by a microprocessor, which works during the swing phase. This study compared the biomechanical gait parameters for transfemoral amputees at different cadences with those for healthy volunteers and examined the functional performance and subjective evaluation of the prototype compared to those for the prosthetic knees currently being used. Subjects and Procedures. Three male unilateral transfemoral amputees, who had been using a prosthesis for more than 3 yr, with midthigh amputations caused by trauma, participated in this study. Ten male healthy volunteers were used for collecting normal biomechanical data for comparison with those of the amputees. We chose the 3R60 prosthetic knee (Otto Bock Orthopedic Industry, Inc.) to compare with the prototype in this study. The biomechanical data from two force plates (9286A, Kistler Instrument Corp.) and a 3-D motion analyzer (VICON140, Oxford Metrix Ltd.) were converted simultaneously and recorded as digital data in a personal computer Gateway Performance 700, Gateway Companies, Inc.). Three different cadences (88, 96, 104 steps/min) were adopted in this study. We measured the stance duration, the peak angle of the knee flexion each at the early stance and in the swing phase, the peak angle of the hip extension and flexion, and the peak moment of the hip extension to compare the two different knees. The data were analyzed with the Kruskal Wallis test with the use of statistical analysis software (SPSS 7.5J for Windows). A significant p-value was <0.05. Results. The stance duration, the peak knee flexion angle at the early stance and during the swing phase, and the peak hip flexion angle in the healthy volunteers showed no significant variation of the values at the different cadences. On the other hand, the peak hip extension moment increased corresponding to the increase in cadence. The values of the biomechanical parameters for the transfemoral amputees were different from those for the healthy volunteers. The stance duration, the peak knee flexion angle at the early stance and during the swing phase, and the peak hip flexion angle tended to be smaller than those of the healthy volunteers. The peak hip extension moments in the amputees were bigger than those in the healthy volunteers. In a comparison of the data for the individual at the different cadences, almost all the parameters showed no significant variation of the values in the prototype. Only one case showed a statistically significant change in the peak knee flexion angle during the swing phase. One of the three subjects showed a difference of peak hip extension moment at the different cadences. All parameters at the different cadences showed statistically significant variation in the values in at least one of three subjects. All subjects recognized an increased stability and ease of swing in the prototype. They also felt that the weight of the prototype was lighter than that of the 3R60, despite the prototype weighing 0.24 kg heavier. All subjects felt uncomfortable at the slow cadence and an unreliable resistance at the rapid cadence during the swing phase in the 3R60. One subject expressed concern about possible knee collapse during the stance phase at the slow cadence in the 3R60. Relevance to the Veteran Population. The data presented here can serve as objective information about biomechanical investigations of transfemoral prostheses for veteran amputees. Most of the values of the prosthetic gait parameters with the prototype showed no significant variation in individuals in the different cadences, which was also demonstrated in the healthy volunteers. Although the prototype needs further improvement for practical use, recent mechanical and microelectronic technology could address this practical issue and produce an easy-to-operate prosthesis benefiting veteran amputees, contributing to a stable walk even at different cadences.

Kazutoshi Yokogushi, PhD

Shape and volume change in the transtibial residuum over the short term: Preliminary investigation of sx subjects

Santosh G. Zachariah, PhD; Rakesh Saxena, PhD; John R. Fergason, CPO; Joan E. Sanders, PhD

Purpose of the Work. This research determined how much a residual limb changes volume and shape after prosthesis removal and over a 2-week period. Subjects and Procedures. A custom optical scanner was used to image the residual limbs of six transtibial amputee subjects. Results. Changes in volume over a 35-minute interval after prosthesis removal were greater than those experienced over a 2-week interval. In four of the six subjects, 95% of the volume increase was reached within 8 minutes of prosthesis removal. No consistent proximal-to-distal trend emerged in the cross-sectional area change. Relevance to the Veteran Population. Results from this study provide a base from which to investigate the fluid movement responsible for the shape changes.

Joan E. Sanders, PhD
Questionnaire for Persons with a Transfemoral
Amputation (Q-TFA): Initial validity and reliability
of a new outcome measure
Kerstin Hagberg, PT; Rickard Brånemark, MD, PhD;
Olle Hägg, MD, PhD

Purpose of the Work. The Questionnaire for Persons with a Transfemoral Amputation (Q-TFA) is a new self-report outcome measure primarily designed for nonelderly persons having a transfemoral amputation to reflect current prosthetic use, mobility, problems, and health. Q-TFA is also developed to study outcome when an individual changes from a conventional socket prosthesis to a direct bone-anchored prosthesis, using the method of osseointegration. The objective of the present study was to assess the initial validity and reliability of the Q-TFA. Subjects and Procedures. To assess measurement properties of the Q-TFA, 156 persons (67% male, 92% nonvascular cases, mean age 51 years, mean years since amputation 25 years) currently using a socket prosthesis answered the Q-TFA and Short Form-36. Test-retest reliability was assessed on a subgroup of the sample (n = 48). Results. The results of this study support adequate clinical sensibility, criterion validity, test-retest reliability, and internal consistency of the Q-TFA on persons using a transfemoral socket prosthesis. Relevance to the Veteran Population. The Q-TFA could be a useful tool for clinicians to assess veterans having a transfemoral amputation.

Kerstin Hagberg, PT

A new hip-knee-ankle-foot sling: Kinematic comparison with a traditional ankle-foot orthosis

Arturo Zancan, MD; Maria V. Beretta, Micaela Schmid, PhD; Marco Schieppati, MD

Purpose of the Work. This study performed a kinematic analysis of a new, simple, low-cost sling for the lower limb, compared to a common ankle-foot orthosis (AFO). Subjects and Procedures. Gait with no orthosis, with AFO, and with the new sling was evaluated in one hemiplegic subject with the use of a movement analysis system. Results. The proposed sling for the lower limb improved the affected ankle kinematics equally to the traditional AFO, and it also improved some gait variables in this hemiplegic subject. Relevance to the Veteran Population. The data could spur future studies evaluating the clinical application of the proposed sling in the early phases of a rehabilitative program involving subjects suffering from hemiplegia, either caused by traumatic brain injuries or cerebral vascular accidents.

Arturo Zancan, MD

Measures of postural stability

Hans Chaudhry, PhD; Thomas Findley, MD, PhD; Karen S. Quigley, PhD; Bruce Bukiet, PhD; Zhiming Ji, PhD; Tiffany Sims, MS; Miriam Maney, MS

Purpose of the Work. This study defined a more biomechanically appropriate measure of postural stability derived from dynamic posturography than is currently available. Subjects and Procedures. We defined a new Postural Stability Index (PSI) and demonstrated that it has a more lawful relationship with average sway angle in veterans with medically unexplained symptoms, nonveterans with chronic fatigue syndrome, and healthy control subjects than does a more commonly used clinical balance score, namely, the equilibrium score. Results. We describe the formula and meaning of the new Postural Stability Index (PSI) and show the relationship of PSI to average sway angle in standing human subjects. Relevance to the Veteran Population. The new measure is intended to provide a more sensitive index of postural stability for clinical use in both veteran and nonveteran rehabilitation clinics.

Karen S. Quigley, PhD

Comparison of the effects of laser and ultrasound treatments on experimental wound healing in rats

Hüseyin Demir, MD; Solmaz Yaray, MD; Mehmet Kirnap, MD; Kadir Yaray, PhD

Purpose of the Work. Problems in wound healing are still the cause of significant morbidity and mortality, and a great number of studies have been conducted on the acceleration of wound healing. These studies increased our knowledge and understanding of pressure ulcers, diabetic ulcers, open wounds, and venous ulcers, all conditions that affect the veteran population. Subjects and Procedures. To investigate the effects of ultrasound and laser treatments on wound healing in rats, we performed this randomized control trial on 124 healthy female Swiss-Albino rats. The rats were divided into four groups. Group I was given pulsed ultrasound treatment, Group III received a full-contact, continuous gallium-arsenide laser therapy. The remaining two groups (Group II and IV) were considered the control groups and received sham treatment. All groups were treated for 10 days. Ten rats in every group were killed on the 4th, 10th, and 25th days for the evaluations of biochemical and histopathologic and biomechanical parameters. Results. At the end of the study, we found that ultrasound and laser treatments both have beneficial effects in the inflammatory, proliferation, and maturation phases of wound healing compared with their control groups. Laser treatment, however, was found to be more effective than ultrasound treatment in the inflammatory and proliferation phases. Relevance to the Veteran Population. Chronic wounds are problems common to the veteran population. Ultrasound and laser treatments have beneficial effects in the inflammatory, proliferation, and maturation phases of wound healing. Laser and ultrasound treatments can be used successfully for decubitis ulcers and chronic wounds when used with conventional therapies such as debridement and daily wound caring.

Hüseyin Demir, MD

Is there a standard of care for eccentric viewing training?

Joan A. Stelmack, OD, MPH; Robert W. Massof, PhD; Thomas R. Stelmack, OD

Purpose of the Work. Persons with low vision from macular or other retinal diseases frequently have disturbances in their central vision, resulting in blur, distortion, or blind spots caused by damage to their retina. To compensate, visual skills instructors teach eccentric viewing (EV) use of alternative areas of healthy peripheral retina. We conducted a study to determine the current methods of evaluation and instruction used in Department of Veterans Affairs (VA) blind rehabilitation centers (BRCs) and vision impairment centers to optimize remaining sight (VICTORS) programs. Procedures. A questionnaire was mailed to all VA BRCs and VICTORS. Results. While all respondents of programs reported that they provide EV training, considerable variation was found in the time spent in instruction and the techniques used for both evaluation and training. Relevance to the Veteran Population. Research studies are needed to determine which patients will benefit from EV training and the specific procedures to use for best results.

Joan Stelmack, OD, MPH

Usage, performance, and satisfaction outcomes for experienced users of automatic speech recognition

Heidi Horstmann Koester, PhD

Purpose of the Work. Automatic speech recognition (ASR) can potentially improve the productivity and comfort of computer use. This study assesses how well ASR systems are meeting the needs of users with physical disabilities. Subjects and Procedures. Participants included 24 experienced users of ASR systems who have physical disabilities. An in-person survey interview was conducted to assess usage of ASR (how often, for what kinds of tasks), satisfaction with its use, and other aspects of their experiences with ASR. Usage and satisfaction with any nonspeech input methods used by these subjects were also assessed. Users then performed a series of word processing and operating system tasks with their ASR systems. For users who also used a nonspeech input method, such as a keyboard and/or mouse, performance without speech was also measured. Results. The top reason participants gave for using ASR was to reduce fatigue and pain associated with manual input methods. Users' main concern with ASR is the inconsistent recognition accuracy. Almost all participants had a nonspeech input method they used in conjunction with ASR. About half of those who had a choice used ASR for 25% or less of their computer tasks. The average satisfaction with ASR was greater than neutral, but not overwhelmingly positive. The time required for nontext tasks was significantly slower with ASR than without. The average text entry rate with ASR was 16.9 words per minute (wpm), with a range of 3.5 to 32.2 wpm. The average recognition accuracy with ASR was 85%. Relevance to the Veteran Population. ASR appears to be particularly successful in reducing the pain and fatigue that can be associated with manual input methods. It does not necessarily improve productivity relative to other nonspeech input methods. Results suggest that users who manually type faster than 15 wpm are less likely to enjoy a speed enhancement using ASR. The use of appropriate correction strategies with ASR helps users achieve better performance.

Heidi Horstmann Koester, PhD

Go to TOP

Go to the Contents of Vol. 41 No. 1