Volume 51 Number 8, 2014
Pages xvii — xx
The prevalence of Veterans with dementia in
the Veterans Health Administration is estimated to
be 275,000 annually over the next decade, with an
average yearly incidence of 89,000. In addition to
associated interpersonal, social, and financial costs,
there will be an inevitable increase in burden among
care providers. In a sample of Veterans, we analyzed
dimensions of caregiver burden as they relate to
neuropsychological functioning and found that aspects
of cognitive functioning differentially influence
perceptions of caregiver burden. Determining
the relationship between cognitive functioning and
burden has implications for how to best provide care
to an aging Veteran population.
A better understanding of individual difference
factors and comorbid conditions related to pain may
be useful for identifying individuals at the greatest
risk for developing complex and persistent symptoms
following combat. The present study reveals
that older age, mild traumatic brain injury (TBI)
characteristics, depression symptoms, and posttraumatic
stress disorder re-experiencing symptoms are
related to self-reported pain among military personnel
exposed to blasts during combat. Clinical
interventions frequently target pain, psychiatric, and
TBI symptoms separately; however, the significant
associations between these conditions suggest that integrated treatment approaches that address the
significant overlap in polytraumatic injuries may
better meet Veterans’ needs.
Exposure to psychologically traumatic events is
an inherent aspect of military combat and often leads
to posttraumatic stress disorder (PTSD). Because of
the insurgents’ heavy use of explosive munitions,
U.S. servicemembers of Operation Enduring Freedom,
Operation Iraqi Freedom, and Operation New
Dawn have experienced an especially high rate of
exposure to blast-related traumatic events. This study
assesses how well a commonly used PTSD screening
tool, the PTSD Checklist, detects PTSD in blastexposed
servicemembers. The findings should help
clinicians and researchers better understand how to
measure PTSD in these patients.
Little research describes which design features
of a transfemoral socket (e.g. ischial containment
[IC] and medial tissue loading) are important for
coronal plane stability, socket comfort, and gait.
The results of our pilot randomized crossover study
suggest that medial tissue loading contributes little
to coronal plane stability and comfort in a well-fitted
IC socket and are consistent with classic theory describing the importance of soft tissue loading
along the proximal-medial aspect of the residual
limb in sockets without IC.
This study evaluated a custom wheelchair seat
made of interwoven straps in three Veterans with spinal
cord injuries. Seating pressures were not affected
following common wheelchair activities such as
wheeling and transferring. Also, therapists were able
to customize the strap lengths to obtain acceptable
pressure distributions for the subjects in 4 to 40 min.
This study can help inform future studies that test the
long-term use of strap-based wheelchair seats and
that help identify which individuals would most benefit
from rapidly customizable strap-based seating.
An effective wheelchair cushion is essential to
prevent pressure ulcer development, enabling the
individual to achieve optimal mobility function and
quality of life. Use of an alternating-pressure air cushion
(APAC) may provide regular automatic weightshifting.
A repeated-measures study of thirteen adult
full-time wheelchair users with spinal cord injury was
carried out to determine whether APAC use provides
reliable, effective pressure relief compared with
independent pressure relief (IPR). We found that IPR
positively affects multiple aspects of tissue health but
produces brief improvements. APAC use provides
dynamic and continuous weight-shifting with more
sustained positive tissue health effects.
The ProprioFoot is a motorized, microprocessorcontrolled
foot that imitates normal ankle motions
of dorsiflexion during the swing phase of gait. This
study found that people with transtibial amputation
using the ProprioFoot walk in a way that decreases
their chances of tripping over an obstacle compared
with wearing other prosthetic feet without the
motorized motion. The findings suggest that individuals
who often trip or walk over inclines and uneven
surfaces may benefit from this foot. Overall, using
the ProprioFoot may improve safety.
Veterans with lower-limb loss who use a prosthetic
limb move with different joint angles and joint
forces in their sound and amputated limbs. Clinicians
normally try to create symmetry in limb movement,
assuming that joint forces will also become symmetrical.
This study used cycling to define how differences
in joint angles and joint forces were related.
Our results imply that reducing differences in joint
angles does not affect joint loading as assumed in
clinical practice. We propose that clinicians should
define an acceptable amount of asymmetry and use
that information to improve rehabilitation.
Poor biopsychosocial functioning and low levels
of pain self-efficacy (an ability to tolerate pain and
complete daily activities despite pain) have been
found to contribute to higher pain severity. This study
examined the relationship between biopsychosocial
functioning and pain severity and evaluated whether
pain self-efficacy indirectly affects this relationship.
The results indicate that social functioning is an
important factor in predicting pain severity and pain
self-efficacy. It is necessary to consider social functioning
when trying to understand the development
of difficulties in patients with chronic low back pain.
Previous literature reports greater metabolic
demand of walking following amputation. However,
the subject populations were generally older and less
fit than current servicemembers. This study compared
energy expenditure in young, active individuals with
below-knee amputations and healthy nondisabled
individuals during walking. Energy expenditure was
not different between groups across a wide range of
walking speeds. Despite missing part of a limb, individuals
with amputation rated their walking abilities
as very high and did not find walking challenging.
Young, active servicemembers may expect energy
expenditures lower than those indicated by previous
reports on older, less active patients with amputation.
For individuals who depend on a wheelchair for
mobility, sitting-acquired pressure ulcers are a common
and life-endangering complication. In patients
with a spinal cord injury in particular, changes that
affect the weight-bearing tissues of the buttocks may
increase the risk for pressure ulcers, exposing this
already-at-risk population to the additional potential
risk caused by soft tissue scarring. Here, we used
computational modeling to evaluate the biomechanical
efficacies of an air-cell-based cushion for individuals
who have previously experienced pressure
ulcers that healed but left different types of scars.
Our simulations indicate that an air-cell-based cushion
is adequately protecting patients with a history of
severe pressure ulcers manifested by large, possibly
deep tissue scarring in their buttocks.
We surveyed and interviewed staff at four Polytrauma
Rehabilitation Centers about the implementation and
sustainability of the Family Care Map. Staff perceptions
about sustainability were related to their commitment
to change as well as involvement during
implementation. The study indicated that sustainability
of the Family Care Map occurs when its principles
have been integrated into daily workflow and
organizational culture. Outdated information in the
Family Care Map and lack of staff awareness and use
represent barriers to sustainability.
Diabetes is highly prevalent in the U.S. population,
and especially so among veterans, resulting in a
10- to 20-fold increased risk of lower-limb amputations
(LLAs). LLAs are burdensome, both in terms of
healthcare costs and for the patient’s quality of life.
This study is a cross-sectional analysis of Veterans
Health Administration (VHA) clinic users identified
as having diabetes with nontraumatic LLAs in fiscal
years 2004 and 2010. LLA expenditures related
to inpatient surgery, pharmacy, and outpatient care
were evaluated. The main objective was to estimate
the economic burden of diabetes-related LLAs in the
VHA system in fiscal years 2004 and 2010.
Many veterans have problems with their balance
due to conditions such as aging, traumatic brain injuries,
amputations, war-related injuries, and concussions
that require rehabilitation. We have developed
a novel balance rehabilitation and training apparatus
to help individuals improve their functional balance
and minimize their fear of falling and fall risk. We
performed scientific research on this apparatus to
determine whether it provides the benefits for which
it was designed and to show it works in a “real-world”
setting. We confirmed the apparatus could be a valuable
tool to help rehabilitate individuals with balance
impairments and improve their quality of life.
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Last Reviewed or Updated Thursday, January 15, 2015 9:51 AM