Journal of Rehabilitation Research & Development (JRRD)

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Volume 47 Number 7, 2010
   Pages xi — xiv

JRRD at a Glance

New protocol for construction of eyeglasses-supported provisional nasal prosthesis using CAD/CAM techniques

Leonardo Ciocca, DDS, PhD, et al.

Figure 7. Silicone prosthesis (a) before and (b) after finishing operations and connection to eyeglasses.Silicone nasal prostheses are sometimes necessary for aesthetic reasons, respiratory function, and social relationship recovery. Because medical adhesives and mechanical support (e.g., eyeglasses) may not function properly, osseointegrated craniofacial implants are the best method for retaining nasal prostheses. However, an implant-supported nasal prosthesis takes a long time to manufacture and patients require an acceptable aesthetic appearance as soon as possible. Therefore, an eyeglasses-supported nasal prosthesis may be a temporary solution and may need to be part of the permanent prosthesis when insufficient bone exists for implant placement. This article discusses a new protocol for making an immediate provisional eyeglasses-supported nasal prosthesis with use of laser scanning, computer-assisted technology, and virtual modeling. This protocol reduces design and manufacturing time and nasal prostheses costs compared with traditional methods.

A culturally sensitive Transition Assistance Program for stroke caregivers: Examining caregiver mental health and stroke rehabilitation

Paul B. Perrin, MS, et al.

Figure 2. Depression, as measured by Center for Epidemiologic Studies Depression (CESD-10) scale, scores for caregivers below threshold for depression at baseline by treatment group (n = 27). Scores reported for each time frame represent mean scores for each respective group. Graph includes only caregivers who were below threshold of 10 for depression at baseline. Bold line represents threshold value (10) for depression on this instrument.

Approximately 80% of stroke survivors are discharged home to continue recovery. Caregivers play a key role in supporting recovery at home. Caregivers need help to provide care to veterans after discharge. They may experience strain, burden, and depression. We conducted a pilot study on a telephone support program, the Transition Assistance Program (TAP), that provides education, support, and problem solving to assist caregivers in caring for veterans poststroke. We found that the TAP reduced caregiver strain at the 3-month follow-up and that the TAP may have prevented an effect on depression. We also found that veterans with low functioning at baseline whose caregivers received the TAP improved in functioning more than the veterans whose caregivers did not receive the TAP. Our findings reveal that the TAP warrants further research.

Influence of gravity compensation on kinematics and muscle activation patterns during reach and retrieval in subjects with cervical spinal cord injury: An explorative study

Marieke G . M. Kloosterman, PT, MSc, et al.

Figure 1. Freebal device for gravity compensation of upper limb. Source: Stienen AH, Hekman EE, Van der Helm FC, Prange GB, Jannink MJ, Aalsma AM, Van der Kooij H. Freebal: Dedicated gravity compensation for the upper extremities. In: Proceedings of the 2007 IEEE 10th International Conference on Rehabilitation Robotics; 2007 Jun 13???15; Noordwijk aan Zee, the Netherlands. Piscataway (NJ): IEEE Press. p. 804???8.DOI:10.1109/ICORR.2007.4428517

After a cervical spinal cord injury, a patient should integrate exercise therapy in an intensive rehabilitation program in optimizing the remaining upper-limb function. During rehabilitation, arm support (gravity compensation) is often used to facilitate goal-directed movement of the upper limb, compensate for lost functions, or train movements. However, the specific effect of gravity compensation on kinematics and muscle activation is largely unknown. In this explorative study, results showed that gravity compensation influenced the kinematics and amplitude of muscle activation of the upper limb; however, the timing of muscle activation remained unaffected.

An indentation apparatus for evaluating discomfort and pain thresholds in conjunction with mechanical properties of foot tissue in vivo

Shuping Xiong, PhD, et al.

Figure 1. Mechanical configuration of automatic tissue tester: (a) front view and (b) top view.

This article describes an apparatus for measuring the discomfort and pain thresholds and the mechanical properties of human tissues. The apparatus is automatic, flexible and cost-effective, and test results indicate that it is accurate and reliable. Applications of the apparatus include detecting foot tissue abnormalities, developing orthopedic footwear and accessories, and providing information for building finite element models.

Long-term use of custom-made orthopedic shoes:
1.5-year follow-up study

Jaap J. van Netten, MSc, et al.

Many veterans experience problems with their feet and/or ankles for which orthopedic shoes may be prescribed. Our long-term follow-up study investigated whether patients continue to use their orthopedic shoes after 1.5 years. We found that patients who were less satisfied with their shoes in the short term were less likely to use their shoes after 1.5 years. Clinicians and shoe technicians should pay extra attention to those patients who are initially dissatisfied with their orthopedic shoes in order to prevent them from giving up use of their shoes in the long term.

Pressure profile similarities between tongue resistance training tasks and liquid swallows

Catriona M. Steele, PhD, et al.

Figure 3. Forest plot showing the overlap in mean and 95% confidence interval for tongue-pressure release slope, measured at posterior palate, during eight different tasks: discrete water swallow (DSW), discrete nectar-thick apple juice swallow (DSANEC), noneffortful saliva swallow (NESS), effortful saliva swallow (ESS), posterior emphasis half-maximumtongue-palate press (PHMAX), PHMAX performed at slow rate (PHMAXSLOW); PHMAX performed at fast rate (PHMAXFAST), and posterior-emphasis maximum isometric tongue-palate press (PMAXTP). Dashed lines outline interval capturing release-slope values for DSW and DSANEC. Tasks with mean and confidence interval boundaries falling outside these lines differ from these bolus swallowing tasks in release slope.

Swallowing problems are a serious concern for many veterans, elderly people, and individuals with strokes or brain injuries. Tongue function is critical for swallowing. Research suggests that tongue resistance exercises can improve strength but not whether they improve swallowing. This study explored how nondisabled people apply tongue pressure to liquids during swallowing and compared these pressure patterns with those seen during different tongue resistance exercises. We identified tongue resistance exercise tasks with similar pressure profiles to nondisabled swallowing. We suggest that treatment should focus on these tasks to have the best chance of improving swallowing.

Wheelchair axle position effect on start-up propulsion performance of persons with tetraplegia

Orestes Freixes, PT, et al.

Figure 1. Seat position matrix. 1 = position 1, 2 = position 2, 3 = position 3, and 4 = position 4

People with tetraplegia have weakness in their arms that can cause difficulties with wheelchair propulsion. Because of their poor muscular performance, maximizing their propulsion efficiency is important. We studied wheelchair propulsion at four different axle positions in people with chronic cervical 6 tetraplegia. The wheelchair axle position affects speed, acceleration, stroke frequency, and shoulder range of motion. We found that the up and forward axle position resulted in a more conducive position to stroke frequency than the other positions we analyzed.

Audiometric hearing status of individuals with and without multiple sclerosis

M. Samantha Lewis, PhD, et al.

Figure 2. Model-based estimates for difference in mean pure tone air-conduction thresholds and 95 percent confidence intervals* between subjects with multiple sclerosis (MS) and control subjects without MS. *Confidence intervals that do not span 0, indicated by the dashed reference line, are frequencies showing statistically significant differences (p < 0.05).

We wanted to answer whether people with multiple sclerosis (MS) have more or less hearing loss than people without MS and whether people with relapsing-remitting MS (RRMS) have more or less hearing loss than people with secondary progressive MS (SPMS). We tested the hearing of 47 people with MS, 26 with RRMS and 21 with SPMS, and 49 people without MS. Our study showed that people with MS have more hearing loss than people without MS and that people with SPMS have more hearing loss than those with RRMS.

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