Journal of Rehabilitation Research & Development (JRRD)

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Volume 48 Number 2, 2011
   Pages xvii — xix

Measurement of community reintegration in sample of severely wounded servicemembers

Linda Resnik, PT, PhD, et al.

Figure 2. Percent of sample with changes greater than minimal detectable change (MDC) of Community Reintegration of Servicemembers(CRIS) measure.

Community Reintegration of Servicemembers (CRIS) is a new measure of community reintegration. Prior to the current study, the measurement properties of CRIS had not been examined in younger veterans or in those with severe injuries. This study tested CRIS with seriously injured combat veterans. We collected data from 68 subjects from the Center for the Intrepid in two sessions 3 months apart. We examined reliability, validity, and responsiveness of CRIS. Results suggest that CRIS is a sound test to measure community reintegration in severely wounded servicemembers.

Respiratory muscle pacing with chronically implanted intramuscular Permaloc electrodes:
A feasibility study

James S. Walter, PhD, et al.

Superficial muscles of lateral upper-thorax area during autopsy. Poly-propylene anchors of two dissected Permaloc electrodes are shown at arrows. They are located at third and fourth intercostal spaces. Their location overlying serratus and latissimus muscles shows that the electrodes became dislodged from underlying intercostal muscles where they had been implanted. Electrodes were implanted for 40 days.

In patients with upper-cervical spinal cord injury, ventilation is maintained with a respirator or by phrenic nerve stimulation. Ventilation can also be augmented by upper- thorax stimulation during inhalation and abdominal-muscle stimulation during exhalation. In the current investigation, we report results with chronically implanted intramuscular electrodes located in the diaphragm, upper thorax, and abdominal muscles. Combined diaphragmatic and upper-thorax stimulation followed by abdominal-muscle stimulation increased the tidal volumes compared with diaphragmatic stimulation alone. Further studies must develop techniques that ensure stable anchoring of chronically implanted intramuscular electrodes and determine the best location and stimulation parameters to augment ventilation.

Telerehabilitation assessment using the Functioning Everyday with a Wheelchair-Capacity instrument

Richard M. Schein, PhD, et al.

For many veterans, traveling to a medical center or hospital can be a complicated and sometimes difficult task because of where they live, their diagnosis, or a lack of transportation. The Department of Veterans Affairs has been recognized as a leader in telehealth. Specifically, telerehabilitation allows the delivery of rehabilitation services remotely. In this study, we used videoconferencing technology to allow an expert practitioner to connect with a client and other practitioners more than 100 miles away to examine how individuals functionally operate their wheelchairs and to recommend new wheeled mobility devices. This technology will decrease travel time and assist with care coordination.

Medical utilization and cost outcomes for poststroke veterans who receive assistive technology devices from the Veterans Health Administration

Sandra L. Hubbard Winkler, PhD, OTR/L, et al.

This study examined the relationship between provision of assistive technology devices (ATDs) and healthcare consumption and outcomes in a system that does not limit provision of ATDs to in-home use and determined how the provision of ATDs relates to inpatient/outpatient use and costs of services for veterans 12 months poststroke. This retrospective study used Department of Veterans Affairs administrative/workload databases to identify veterans with stroke. We found that providing mobility ATDs to veterans predicts greater functional gain while in the hospital and, most notably, greater outpatient visits, indicating these devices may enable better outpatient healthcare. However, ATD recipients did have longer length of stay.

Driving electromechanically assisted Gait Trainer for people with stroke

Marco Iosa, PhD, et al.

Gait Trainer (GT): (a) Frontal and (b) lateral views of nondisabled subject performing GT session, and (c) GT controller showing number of strides performed (not number of steps, as incorrectly shown on GT controller) and effective body-weight support measured by GT dynamometer. At bottom are step length selector and walking speed selector (which is actually cadence selector).

In the last decade, devices for electromechanically assisted gait training have been developed to allow nonambulatory patients to practice intensive, task-oriented exercise. Our review of this training focuses on body-weight support, walking speed, and harness accelerations. Our original study provides interesting results suitable for properly selecting parameters in electromechanically assisted gait training that can increase the treatment effectiveness for patients with subacute stroke.

Trainer variability during step training after spinal cord injury: Implications for robotic gait-training device design

Jose A. Galvez, PhD, et al.

Figure 3. Example of statistical analyses. Plot shows knee extension force during midstance for each trainer versus trainer skill rating in training session for leg of patient with spinal cord injury. From data such as these, we calculated correlation coefficient and significance of correlation. Triangles denote confidence intervals at p < 0.05 for means of knee extension force (fy, knee) for each trainer (for three bouts of 20???30 steps each). We noted significant differences between pairs of trainers when such confidence intervals did not overlap.

Over 2.5 million people worldwide live with spinal cord injury (SCI)-induced paralysis, a condition that affects a large number of veterans. Clinical research has shown that step training with body-weight support on a treadmill (BWST) and manual assistance can benefit people with SCI. Worldwide efforts are being made to automate BWST training with robotic devices. We measured the movements and forces that therapists exerted on patients during BWST training to assess the most effective manual training patterns and to use them to design more effective robotic gait-training strategies.

Effect of prosthetic design on center of pressure excursion in partial foot prostheses

Michael P. Dillon, PhD, BPO(Hons), et al.

Experimental prosthesis, including pelite liner, laminated socket, and leg shells with Velcro closures. Camber-axis joints are joined to socket (inferiorly) and anterior leg shell (proximally). Distal forefoot includes series of band saw cuts to allow forefoot to deform to desired roll-over shape. Note the plastic shims that could be fully inserted into every second cut to obtain ???stiff??? forefoot condition. Removal of all shims created ???compliant??? forefoot condition. Retroreflective markers were screwed into joint axes during static trials (as pictured). During dynamic trials, medial retroreflective marker was replaced with screw and locking washer.

Research on the gait of people with partial foot amputation suggests that effective foot length can be restored if the prosthesis has a stiff forefoot, has an above-ankle anterior shell, and restricts dorsiflexion. By independently manipulating these design features of the prosthesis in two participants with partial foot amputation, we showed (using three-dimensional motion analysis) that the prosthesis must include each of these design features to restore effective foot length. When these design features were used at the same time, the participants' gait pattern was more like that of people without limb loss.

Multiple vibration displacements at multiple
vibration frequencies stress impact on human
femur computational analysis

Bertram Ezenwa, PhD; Han Teik Yeoh, PhD

Maximum stress levels of femur model: (a) 35.77, (b) 53.66, (c) 107.30, and (d) 214.62 MPa.

Veterans who are bedridden while recovering from injuries will benefit from technology that initiates muscle contraction to improve bone strength when they are unable to engage in physical activities. This article presents the development and pilot test called multiple vibration displacements at multiple vibration frequencies (MVDMVF) for efficient recruitment of muscle groups while a patient stands on the platform. The advantage of MVDMVF is that the use of high displacement levels is unnecessary for improving bone strength because of efficient muscle recruitment. Our results from testing MVDMVF on a veteran subject showed that MVDMVF improved bone strength. We also included the veteran's comments about comfort of use.

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Last Reviewed or Updated  Friday, February 11, 2011 8:32 AM