Volume 51 Number 2, 2014
Pages xix — xxi
Impairment of human ocular accommodation, or
eye focusing, is common in those with mild traumatic
brain injury (mTBI). Its presence can adversely
affect near work activities and general activities of
daily living because words and objects would be
"blurry." Following 3 h of eye focusing training,
nearly all aspects of accommodation improved significantly,
along with reduced symptoms and improved
visual attention. There was no effect of the
placebo training. These findings demonstrate considerable
residual neural/visual system plasticity in the
adult brain with mTBI.
Gait is a challenging activity for people with
transtibial amputation who must cope with the loss
of ankle muscles. Particularly, slope walking, a daily
situation, must be addressed during rehabilitation.
The role of the individual muscular capacity and
functional ability was investigated through a quantified
analysis of gait of seven transtibial patients.
Walking strategies are clearly related to the muscular
impairment, suggesting hip and knee extensors
strengthening as a priority. The six-minute walk
test, a good predictor of uphill walking ability, can
be proposed as a functional score usable in clinical
routine for rehabilitation evaluation of people with
In this study, the effects of resting, standing, and
walking on residual limb fluid volume were measured.
Results from 24 participants with transtibial
amputation showed that standing caused fluid volume
losses, while walking and resting caused fluid
volume gains in some subjects and fluid volume losses
in other subjects. The nature of activity is important
when considering carrying out volume accommodation
People with stroke and chronic gait disability
participated in a 3 wk, 3 sessions per week robotics
training program using their affected ankle to play
video games. Half of the participants were given encouragement,
performance feedback, and the opportunity
to win money during each session. The other
half trained equally on the ankle robot but received
none of the immediate reinforcements presented to
the first group. The high reward group learned faster
and improved certain aspects of their walking. Electrical
brain activity was also recorded before and after
training and showed that after training, the high
reward group had more efficient brain networking
during ankle movements.
Getting in and out of places remains a problem
for veterans with paraplegia despite advances
in medicine and the passage of the Americans with
Disabilities Act. This study examines the feasibility
of a sensor-based hybrid neuroprosthesis combining
body bracing with automated joints to regulate
movements with functional electrical stimulation of
an individual’s own muscles in providing the ability
to walk. This should provide people with spinal cord
injury options to access places not readily reachable
by wheelchair while at the same time preventing or
reversing degradation of bones, joints, heart, lungs,
and skin due to immobility resulting from paralysis.
Muscle vibrations are known to induce a strong
perception of joint movement in the absence of actual
movement. They can also trigger low-intensity
muscle contractions. Thus, it would be possible,
with the appropriate pattern of vibration, to trigger
a perception of gait movements and small amplitude
stepping-in-place movements. This study tested the
possibility of delivering such complex vibration patterns
to leg muscles and measuring the induced leg
movements. This complex vibration pattern could
activate the central nervous system in a gait-like
manner for rehabilitation of persons with difficulty
walking because of neurological deficits.
The majority of veterans with an upper-limb amputation
use body-powered prostheses rather than
myoelectric prostheses. Body-powered prehensors
may be controlled by either voluntarily opening or
closing the device. This study examined differences
in performance between the two categories. The study
found that voluntary closing devices are faster across
tasks and preferred for some tasks, whereas voluntary
opening devices are preferred for others. These
results will help clinicians prescribe the most appropriate
device for veterans, allow occupational therapists
to recommend when veterans should switch
between devices for specific tasks, and provide parameters
that enable engineers to design devices that
can switch between modes.
Falls are a serious danger to older veterans and
may lead to injury, loss of independence, and death.
Among cognitively impaired veterans, it is difficult
to determine risk for future falls; walking tasks such
as the Timed Up and Go test may be helpful. We examined
whether three versions of the test detected
potential fallers with cognitive impairment. Results
showed the tasks were associated with cognitive
functioning and successfully differentiated between
infrequent and recurrent fallers. Use of the Timed Up
and Go tasks may prevent future falls and identify
individuals who could benefit from physical therapy
and other falls-prevention strategies.
The study described the psychometric properties of
the Cane Cognitive Mediator Scale (CCMS) and Psychosocial
Impact of Assistive Devices Scale (PIADS)
in adults with osteoarthritis (OA) and determined the
feasibility of using these instruments as screening
tools to identify patients who are likely to use a cane.
The findings indicate acceptable test-retest reliability
for the CCMS Attitudes and Subjective Norms subscales.
Internal consistency reliability was good for
the CCMS and PIADS. The CCMS Subjective Norms
subscale demonstrated acceptable predictive validity
across all subjects, while the PIADS Adaptability subscale
demonstrated acceptable predictive validity for
adults 45 to 64 years old.
The military Veteran population is aging, resulting
in a surge of older patients (65 and older) using
Veterans Health Administration (VHA) services.
These older Veterans also account for a rising number
of posttraumatic stress disorder (PTSD) cases
treated in the VHA. Multiple illnesses at the same
time are common among older Veterans, with effects
seen across lifestyle behaviors, functional ability,
and quality of life. The added burden of comorbid
psychological conditions such as PTSD on physical
performance outcomes in older Veterans has
received little attention to date. Examining the relationship
between PTSD and physical function has
tremendous potential for improving integrated health
care and optimally directing rehabilitation services.
Persons with amyotrophic lateral sclerosis (ALS)
can experience weakness and fatigue of the neck
muscles that hold the head up. In some cases, the
muscles cannot hold the head up and the chin drops
onto the person’s chest, which can interfere with
eating, communication, comfort, and/or breathing.
This article describes a simple device constructed for
persons with ALS to assist with holding the head up
during daily activities, including walking. The article
also describes a 2-week trial of this device by a group
of male veterans with ALS.
Information related to detraining following dysphagia
rehabilitation is highly relevant in populations
with neurodegenerative disease where dysphagia
and aspiration are often considered inevitable.
Individuals with Parkinson disease often succumb to
complications of dysphagia and resulting pulmonary
sequelae. Therefore, long-term dysphagia management
is a top priority throughout the progression of
the disease. Expiratory muscle strength training has
been found to provide specific, clinically meaningful
gains to swallowing and cough function. This preliminary
study highlights the need for the development
of maintenance programs to sustain function
following intensive periods of training.
This article describes new approaches in the
evaluation of shearing and thermal comfort properties
of orthotic insoles for patients with diabetes. In
addition, a novel performance index that combines
various material test results is proposed to quantify
the overall performance of the insole materials. Practitioners
can use the performance index to better understand
the properties and performance of various
insole materials, thus prescribing suitable orthotic
insoles for patients with diabetic foot.
A clear sound can be heard when a vibration signal
is delivered to the aural cartilage from a transducer.
This form of transmission is referred to as cartilage
conduction (CC). This study showed that CC thresholds
were lower than bone conduction thresholds in
the low to middle frequency range for patients with
fibrotic aural atresia in which fibrotic tissue was connected
to the ossicles. Acquired fibrotic aural atresia
is not uncommon in the adult population. The results
suggest that hearing devices using CC can contribute
to rehabilitation of these patients, as well as having
other useful audiological applications.
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Last Reviewed or Updated Tuesday, June 10, 2014 9:56 AM