Browsing by Subject "Rehabilitation"
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Item Open Access An Adaptive Prosthetic Hand with Compliant Joints and EMG-based Control(2005) Carrozza, Maria Chiara; Zaccone, Franco; Micera, Silvestro; Cappiello, Giovanni; Stellin, Giovanni; Vecchi, Fabrizio; Dario, PaoloIn this paper some recent results about the experimental trials we are performing on a functional prosthetic hand characterized by an EMG-control and by a simple and low cost fabrication technology are shown. A compliant under-actuated prosthetic hand has been designed and fabricated. The five-fingered hand (both palm and fingers) is moulded as a soft polymeric single part with compliant joints and embedded tendon driven under-actuated mechanism for providing adaptive grasp. The maximum measured cylindrical grasping force is 30 N. The one DoF prosthetic hand is controlled using two pre-amplified EMG electrodes. The proposed EMG-based control is a Finite State Machine (FSM). A particular attention has been given to the calibration phase. In order to identify the end of the grasp, the intensity of the current is monitored. Moreover, the microcontroller stops the motor when the average current overcomes the value imposed. Compared to other EMG based controllers, the approach proposed is very simple but it presents a good robustness and needs a minimum computational cost.Item Open Access Angulation Osteotomy to Improve Function in Transhumeral Amputee Rehabilitation(2008) Farnsworth, Troy; Lipe, Del; Fergason, John; Granville, Robert; Menetrez, Jennifer; Hillard, AmyRegardless of prosthetic design, there exist inherent limitations which adversely affect the functionality of transhumeral prostheses. Loss of voluntary humeral rotational control, limitations in prosthetic suspension and decreased range of motion limit the user’s acceptance and functional use of a prosthesis. Various techniques have been discussed in the medical literature to compensate for these shortcomings. These include socket design techniques, harness techniques, and surgical techniques. Marquette introduced the concept of humeral angulation osteotomy to resolve these issues. By surgically angling the distal humerus the amputee can be fit with a self-suspending prosthesis that enables voluntary rotational control without restrictions to range of motion. Although this technique is discussed in various prosthetic text books, very few cases have been reported. Case studies will be presented showing surgical, rehabilitation, and prosthetic considerations.Item Open Access Assessing Digital Health Equity in Implementation of Virtual Rehabilitation After Total Knee Arthroplasty Among Older Adults in the U.S.: A Case Example(2021) zhang, ziqiBackground: Digital divide among elderly people is an emerging problem. With more adoption of technology in the health care field, we should be aware of the health inequity generated by the adoption of digital health as the norm after COVID-19 crisis. Objectives: The primary aim of this study is to evaluate the participants’ comfort with technology (self-reported digital literacy) prior to using VERA, a digital health platform for exercise therapy. The secondary aim is to examine the association of patient characteristics and digital literacy with the acceptability, treatment adherence, accuracy of exercises performed, and change in exercise over 90-day intervention. Methods: This cohort study used secondary data from the VERITAS clinical trial (clinicaltrials.gov identifier: NCT02914210). The research analyzed socio-demographics, digital health determinants, and process outcomes at 90-days. Descriptive statistics were conducted, Prevalence Ratio (PR) was used as a measure of association. Results: Participants who were older in age and had less than 16 years of education were less comfortable with technology. Less comfort with technology prior to starting therapy was not associated with lower acceptability, adherence, accuracy, nor change in days per week exercised over 90 days. We found that having a preexisting condition of neurological disorders was associated with lower self-reported adherence. Conclusion: Age and education are related to comfort using technology. We should take them into consideration at the digital health design stage. Besides, we didn’t find unequal use of VERA with the process outcomes among different strata, which means by personalized health intervention and improved usability, people who have disadvantages can also adopt technology to achieve better health. By advocating the human-centered design, digital health can benefit more people to achieve health equity on a large scale.
Item Open Access Assessment of Sea Turtle Rehabilitation in North Carolina(2019-04-26) Stevens, BAs is the case with all sea turtle species, the five species that occur within North Carolina waters are listed as either threatened or endangered under the Endangered Species Act of 1973. Due to their endangered/threatened status, rehabilitation efforts are key for their long-term conservation since the release of healthy individuals helps promote more sustainable populations. In order to ensure rehabilitation efforts are concentrated properly and to assess their success rates, in-depth studies must be done on the stranding records available for each rehabilitation facility within the state. While other states such as Florida and Queensland, Australia have conducted studies to determine their rehabilitation characteristics and success rates, a comprehensive study of a similar nature has never been done with the sea turtle rehabilitation records for the state of North Carolina. This study analyzes the rehabilitation records for the state of North Carolina to determine the most common characteristics of sea turtles admitted for rehabilitation as well as the successful release rates over time. Sea turtle rehabilitation efforts and record keeping began at the North Carolina Aquariums back in the mid-1980s which was soon followed by the opening of the Karen Beasley Sea Turtle Rescue and Rehabilitation Center in 1997. The North Carolina Aquarium on Roanoke Island partnered early with the Network for Endangered Sea Turtles (N.E.S.T.) which eventually became the Sea Turtle Animal Rescue(STAR) Center in 2014. Both the North Carolina Aquariums and the KBSTRRC largely outsourced any necessary veterinary care through a collaboration with North Carolina State University’s College of Veterinary Medicine though the North Carolina Aquariums hired its first full-time veterinarian for sea turtle care in 2015. This study reviews the rehabilitation records of North Carolina to date, presented as two datasets taken from the public North Carolina Aquariums and the private, non-profit Karen Beasley Sea Turtle Rescue and Rehabilitation Center (KBSTRRC). A total of 2707 rehabilitation records were available which was narrowed down to 2594 records for data analysis after a variety of factors including the restriction of the time period used to only include those records from January 1997 to October 2018. Characteristics were determined for the majority of rehabilitation records such as: life stage, sex, stranding causation, stranding location, species, rehabilitation location, rehabilitation outcome, and release location. The successful rate of release was determined and compared against studies done in Florida and Queensland, Australia for comparative purposes. Based on the 2707 records available, both life stage and sex were removed as variables in future data analysis due to skewed proportions for turtles in their juvenile life stage as well as those that did not have their sex determined during rehabilitation. When looking at the restricted 2594 records, the most common sea turtle brought in for rehabilitation in North Carolina was a green sea turtle species, stranded in inshore waters (landward of the Coast Guard’s COLREGS line) due to cold stunning, and successfully released. The most common rehabilitation facility used was the North Carolina Aquarium on Roanoke Island and its affiliates followed by the Karen Beasley Sea Turtle Rescue and Rehabilitation Center, and the North Carolina State University’s College of Veterinary Medicine based in the Center For Marine Sciences and Technology (CMAST). When compared to the other studies looked at, the successful release rate for North Carolina was nearly double the successful release rates seen in both Florida and Queensland, Australia. The results discussed in this study will help rehabilitation facilities in North Carolina better tailor resources and funds to accommodate the most commonly seen characteristics as well as provide a baseline to be compared against for future data analysis within North Carolina, other states, or when looking specifically at one rehabilitation facility.Item Open Access Description of Common Clinical Presentations and Associated Short-Term Physical Therapy Clinical Outcomes in Patients With Neck Pain.(Arch Phys Med Rehabil, 2015-10) Horn, Maggie E; Brennan, Gerard P; George, Steven Z; Harman, Jeffrey S; Bishop, Mark DOBJECTIVE: To determine the effect of clinical presentations of neck pain on short-term physical therapy outcomes. DESIGN: Retrospective analysis of pair-matched groups from a clinical cohort. SETTING: Thirteen outpatient physical therapy clinics in 1 health care system. PARTICIPANTS: Patients (N=1069) grouped by common clinical presentations of neck pain: nonspecific neck pain (NSNP) with duration <4 weeks; NSNP with duration >4 weeks; neck pain with arm pain; neck pain with headache; and neck pain from whiplash. INTERVENTION: Conservative interventions provided by physical therapists. MAIN OUTCOME MEASURES: Neck Disability Index (NDI) and numerical pain rating scale (NPRS) recorded at the initial and last visits. The main outcome of interest was achieving recovery status on the NDI. Changes in NDI and NPRS were compared between clinical presentation groups. RESULTS: Compared with patients presenting with NSNP >4 weeks, patients with NSNP <4 weeks had increased odds of achieving recovery status on the NDI (P<.0001) and demonstrated the greatest changes in clinical outcomes of pain (P≤.0001) and disability (P≤.0001). Patients with neck pain and arm pain demonstrated an increased odds of achieving recovery status on the NDI (P=.04) compared with patients presenting with NSNP >4 weeks. CONCLUSIONS: Treating patients with NSNP within <4 weeks of onset of symptoms may lead to improved clinical outcomes from physical therapy compared with other common clinical presentations.Item Open Access Gaps in the delivery of rehabilitation medical equipment in the digital age.(Journal of pediatric rehabilitation medicine, 2019-01) Lunsford, Christopher; Rosen, Lauren; Biffl, Susan; Ramsey, Justin; Edinger, Jason; Pierce, Wendy; Houtrow, AmyItem Open Access Incentives for Uptake of and Adherence to Outpatient Stroke Rehabilitation Services: A Three-Arm Randomized Controlled Trial.(Archives of physical medicine and rehabilitation, 2021-09-10) Matchar, David Bruce; Young, Sherry Hsueh Yi; Sim, Rita; Yu, Christine Jia Ying; Yan, Xiaoxi; De Silva, Deidre Anne; Chakraborty, BibhasObjective
To determine if rehabilitation uptake and adherence can be increased by providing coordinated transportation (increased convenience) and eliminating out-of-pocket costs (reduced expense).Design
Three-arm randomized controlled trial Setting: Stroke units of two Singapore tertiary hospitals Participants: Singaporeans or permanent residents aged ≥21 years who were diagnosed with stroke and discharged home with physician's recommendation to continue outpatient rehabilitation.Interventions
A Transportation Incentives arm (T), which provides free transportation services, a Transportation & Sessions Incentives arm (T&S), offering free transportation and prescribed stroke rehabilitation sessions, and a control arm, Education (E), consisting of a stroke rehabilitation educational programme.Main outcome measures
The primary study outcome was uptake of outpatient rehabilitation services (ORS) amongst post-stroke patients, and key pre-defined secondary outcomes being number of sessions attended and adherence to prescribed sessions.Results
Uptake rate of ORS was 73.0% for E (CI, 63.8%-82.3%), 81.8% for T (CI, 73.8%-89.8%), and 84.3% for T&S (CI, 76.7%-91.8%). Differences of T and T&S versus E were not statistically significant (p=0.22 and p=0.10, respectively). However, average number of rehabilitation sessions attended were significantly higher in both intervention arms: 5.50 (SD, 7.65) for T and 7.51 (SD, 9.52) for T&S versus 3.26 (SD, 4.22) for control arm (E) (p-value for T vs E =0.017; p-value for T&S vs E =0.000.) Kaplan-Meier analysis indicated that persistence was higher for T&S compared to E (p=0.029).Conclusions
This study has demonstrated a possibility in increasing the uptake of and persistence to stroke ORS with free transportation and sessions. Incentivizing stroke survivors to take up ORS is a new strategy worthy of further exploration for future policy change in financing ORS or other long-term care services.Item Open Access Lessons from the 2015 earthquake(s) in Nepal: implication for rehabilitation.(Disabil Rehabil, 2016) Sheppard, Phillip S; Landry, Michel DPURPOSE: There has been an increase in the number of natural disasters in recent history, and the rate of disability is increasing among survivors. The most recent major natural disaster was the earthquake(s) that occurred in Nepal on 25 April 2015 and 12 May 2015. In total, more than 8500 people were killed and over 18,500 people were left injured. This article aims to demonstrate the role of rehabilitation professionals in post-disaster relief and beyond in Nepal. METHOD: This is an experiential account of physiotherapists present during the earthquake and participating in the post-disaster relief. RESULTS: Rehabilitation professionals played an important role in the acute phase post-disaster by providing essential services and equipment. However, discharge planning emerged as an important role for rehabilitation providers in the early days of post-disaster and signaled a relatively new and innovative function that facilitated the heavy imbalance between little supply and tremendous demand for care. In the coming years, rehabilitation will need to support local initiatives that focus on minimizing the long-term effects among people with a newly acquired disability. CONCLUSIONS: Rehabilitation serves an important role across the continuum in post-disaster relief from the initial stages to the months and years following an event. IMPLICATIONS FOR REHABILITATION: Driven by medical advances in acute field medicine, the relative proportion of casualties following natural disasters is decreasing, while relative rates of disability are rising among survivors. In post-disaster settings, the growing number of people with newly acquired disabilities will be added to the existing proportion of the population who lived with disabilities, creating a significant growth in the total number of people with disabilities (PWDs) in communities that are often ill prepared to provide necessary services. Rehabilitation interventions in the initial stages of emergency humanitarian response can minimize the long-term effects among people with newly acquired disabilities through early activation and prevention of secondary effects. Rehabilitation providers thus appear to have an important mediating effect on outcomes of disabilities in the early stages, but must also be strong partners with PWDs to advocate for social and political change in the long term.Item Open Access Marine Turtle Trauma Response Procedures: A Husbandry Manual(2008-04-18T22:09:39Z) Bluvias, Jessie E.The increased number of sea turtles housed in rescue and rehabilitation facilities, the growing demand for treatment, and the lack of standard guidelines has dictated a need for a comprehensive Sea Turtle Husbandry Manual written for both lay and professional audiences. Through literature searches (including a thorough review of existing protocols and regulations), personal interviews, and a series of internships at professional sea turtle rehabilitation facilities in the US, I have identified the best practices and have fused and formatted them into a step-by-step, photographic manual of basic standards and recommendations. The manual will be published in English, Spanish and French and distributed by the Wider Caribbean Sea Turtle Conservation Network (WIDECAST) to conservationists, managers, veterinarians, and facilities staff in the Wider Caribbean Region in order to encourage and facilitate the best professional care of sick and injured sea turtles during their rehabilitation.Item Open Access Myoelectric Prostheses with Sensorial Feedback(2002) Rios Poveda, AlvaroA design of a control system for myoelectric prostheses is shown based on a microcontroller that can give the possibility for the amputated patient to replace the pressure perception. In addition this design will permit implementation of low cost prostheses in countries with low economic resource.Item Open Access Perceived barriers and supports to accessing community-based services for Uganda's pediatric post-surgical population.(Disability and rehabilitation, 2019-12-15) Barton, Sarah Jean; Sandhu, Sahil; Doan, Isabelle; Blanchard, Lillian; Dai, Alex; Paulenich, Alexandra; Smith, Emily R; van de Water, Brittney J; Martin, Anna H; Seider, Jasmine; Namaganda, Florence; Opolot, Shem; Ekeji, Nelia; Bility, Mathama Malakha; Bettger, Janet PrvuBackground: Access to pediatric surgical intervention in low-income countries is expanding, but investments in post-surgical care have received less attention. This study explored the barriers and supports for school-aged children to access post-surgical, community-based follow-up care in Uganda as perceived by community stakeholders.Materials and methods: This qualitative exploratory case study used in-depth, semi-structured interviews and in-country site visits among Ugandan organizations providing follow-up care to school-aged children in Uganda after surgery. Data from eight interviews and eight site visits were coded, analyzed, and cross-tabulated with a modified grounded theory approach.Results: Four key barriers to community-based follow-up care were identified: discrimination, financial barriers, geographical barriers (including transportation), and caregiver limitations to support recovery. Three key supports to successful access to and participation in community-based post-surgical recovery were identified: disability awareness, the provision of sustained follow-up care, and caregiver supports for reintegration.Conclusions: Increasing awareness of disability across local Ugandan communities, educating caregivers with accessible and culturally aware approaches, and funding sustainable follow-up care programming provide promising avenues for pediatric post-surgical recovery and community reintegration in contemporary Uganda.Implications for rehabilitationMultiple, intersecting factors prevent or promote access to post-surgical community-based services among school-aged children in Uganda.The most prominent barriers to pediatric community reintegration in Uganda include discrimination, lack of financial resources, geographical factors, and caregiver limitations.Community and interprofessional alliances must address disability awareness and sources of stigma in local contexts to promote optimal recovery and reintegration after surgery.Collaborative efforts are needed to develop sustainable funding for community-based care programs that specifically support pediatric post-surgical recovery and reintegration.Efforts to provide appropriate and empowering caregiver education are critical, particularly in geographical regions where ongoing access to rehabilitation professionals is minimal.Item Open Access Scarf Injuries in Bangladesh: Exploring the Impact on Females who live with Spinal Cord Injuries(2019) Tupetz, AnnaBackground: A growing number of female passengers of a newly-introduced battery powered taxi, referred to as the `Easy Bike´, sustained Spinal Cord Injuries and anterior neck lacerations. This severe injury occurs, as their traditional scarves entangle in the taxi´s engine drive shaft. Injuries sustained by entanglements of scarves in machinery has been known in the literature as Scarf Injuries. This study aimed to conduct key informant interviews to explore Scarf injury survivors challenges in receiving adequate care and maintaining a high Quality of Life (QoL). Methods: We conducted semi-structured in-depth interviews with 12 Scarf Injury survivors and their caregivers after discharge from a rehabilitation center in Bangladesh. Results: The main themes that emerged from the qualitative data were 1) perceived level of health, function and possible participation, 2) access to emergency and acute care and quality of care, 3) challenges in community reintegration. Participants often perceived their ability to perform activities and tasks to be lower than their bodily functions allowed, leading to a self-limitation in their daily social life. Commonly reported health concerns were urinary and bladder control, infections and breathlessness. None of the participants perceived that they received appropriate emergency care at the injury site, and transportation to a medical facility usually occurred in unsafe vehicles due to limitations in general awareness and knowledge of the injury sustained. At the facilities there was a reported gap in knowledge and competencies regarding the etiology of this type of SCI, leading to multiple referrals for diagnosis and delayed management. Community and social reintegration was mainly impacted by lack of financial resources, lack of realistic goals, poor mental health including suicidal thoughts and previously mentioned secondary complications.
Conclusions: Increasing awareness and knowledge about SCI emergency and acute care might contribute to improved long-term clinical outcomes and survival rates among Scarf Injury survivors. Moreover, greater competencies and awareness among providers to manage this unique mechanism of injury would increase the patient´s and caregiver´s level of understanding of their condition, and would result in earlier adoption of a coping process.
Implications: Early rehabilitation that focuses on physical and mental health, alongside empowerment and integration, appears to be lacking in this setting Further studies are needed to identify effective and culturally sensitive intervention programs for females living with Scarf Injuries in LMICs.
Item Open Access The Association between Patients’ Physical Function in the Hospital and Their Outcomes in Skilled Nursing Facilities(Phys Ther Policy Admin Leadership, 2019-11-01) Johnson, Joshua; Fritz, Julie; Brooke, Benjamin; LaStayo, Paul; Thackeray, Anne; Stoddard, Gregory; Marcus, RobinStudy Design. Retrospective observational study. Background. Shifting policies incentivize the appropriate use of skilled nursing facilities (SNFs) by linking reimbursement to patient outcomes. An appropriate recommendation for SNF care following hospitalization is limited by inadequate knowledge of the relationships between clinical presentation in the hospital and the expected outcomes in the SNF. Objectives. The primary objective was to test for relationships between physical function (PF) in the hospital and outcomes in a SNF. Methods and Measures. Data were collected from one academic medical center, five SNFs, and a state all-payer claims database. Primary predictor variables, tested in separate multivariate regression analyses, were PF at hospital admission or discharge. SNF outcomes were PF change, length of stay (LOS), discharge to community, and hospital events occurring within 30 days of hospital discharge. Results. Higher PF at hospital discharge was associated with a 2.3% decrease in SNF LOS (95% confidence interval [CI]=-4.2, -0.3; p=0.025). Trends indicate that those with higher levels of PF at hospital discharge had attenuated PF gains in the SNF (b=-0.13; 95% CI=-0.29, 0.02; p=0.091). No associations were observed between hospital PF and SNF discharge to the community or 30day hospital events. Conclusions. Patients with higher PF in the hospital may expect shorter LOS and potentially attenuated PF gains in the SNF and therefore may not benefit from care in that setting. In larger samples, similar analyses and prospective studies should further explore the associations observed in this study and inform future clinical application.Item Open Access Variation in pediatric traumatic brain injury outcomes in the United States.(Arch Phys Med Rehabil, 2014-06) Greene, Nathaniel H; Kernic, Mary A; Vavilala, Monica S; Rivara, Frederick POBJECTIVE: To ascertain the degree of variation, by state of hospitalization, in outcomes associated with traumatic brain injury (TBI) in a pediatric population. DESIGN: A retrospective cohort study of pediatric patients admitted to a hospital with a TBI. SETTING: Hospitals from states in the United States that voluntarily participate in the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project. PARTICIPANTS: Pediatric (age ≤ 19 y) patients hospitalized for TBI (N=71,476) in the United States during 2001, 2004, 2007, and 2010. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Primary outcome was proportion of patients discharged to rehabilitation after an acute care hospitalization among alive discharges. The secondary outcome was inpatient mortality. RESULTS: The relative risk of discharge to inpatient rehabilitation varied by as much as 3-fold among the states, and the relative risk of inpatient mortality varied by as much as nearly 2-fold. In the United States, approximately 1981 patients could be discharged to inpatient rehabilitation care if the observed variation in outcomes was eliminated. CONCLUSIONS: There was significant variation between states in both rehabilitation discharge and inpatient mortality after adjusting for variables known to affect each outcome. Future efforts should be focused on identifying the cause of this state-to-state variation, its relationship to patient outcome, and standardizing treatment across the United States.