Rehabilitation Hospital of Indiana

College student employment has been increasing steadily for at least four decades. At present, approximately 80% of all college students are employed while completing their undergraduate education. Even among students under the age of 24 at 4-year colleges, more than 50% are employed during the school year. Although some general trends are suggested by empirical research completed to date, studies that evaluate student employment and higher education are at times inconsistent and even contradictory. Despite the high prevalence of student employment, no theoretical models have been developed to explain the relationship between employment and student outcomes. This article briefly reviews the student employment–higher education empirical literature. Possible reasons for inconsistencies are suggested, including challenges posed by methodological issues and the absence of theoretical conceptualization. Some concluding suggestions are offered for addressing these empirical challenges.

This systematic review explored the impact of fall prevention programs and home modifications on falls and the performance of community-dwelling older adults. It was conducted as part of the American Occupational Therapy Association's Evidence-Based Practice Project. Thirty-three articles were analyzed and synthesized. The strongest results were found for multifactorial programs that included home evaluations and home modifications, physical activity or exercise, education, vision and medication checks, or assistive technology to prevent falls. Positive outcomes included a decreased rate of functional decline, a decrease in fear of falling, and an increase in physical factors such as balance and strength. The strength of the evidence for physical activity and home modification programs provided individually was moderate. Implications for practice, education, and research are also discussed.

OBJECTIVE: The purpose of this retrospective case series was to determine whether a long-wave infrared thermography (LWIT, or thermal imaging) camera can detect specific temperature changes that are associated with wound infection and inflammation as compared with normal control subjects with similar anatomical wound locations. DESIGN: A retrospective, observational, collective, multiple case series of patients who underwent digital and thermal imaging of wounds in various states. SETTING: The subjects were selected from multiple sites including an outpatient wound care clinic, a wound care physician's office, a rehabilitation hospital, and a home healthcare organization. PATIENTS: Six subjects were selected for inclusion, including 2 each for the infection, inflammation, and normal control groups. MAIN OUTCOME MEASURE: The study collected relative temperature maximums as obtained and recorded by LWIT and digital imaging. MAIN RESULTS: In this case series, the authors demonstrate the use of an FDA-approved Scout (WoundVision, Indianapolis, Indiana) dual-imaging long-wave infrared and digital cameras to analyze images of wounds. In the 2 cases with clinically diagnosed wound infection, LWIT showed an elevation of temperature as evidenced by a maximum temperature differential between the wound and healthy skin of +4° C to 5° C. Also, LWIT was able to identify relative thermal changes of +1.5° C to 2.2° C in subjects presenting with clinical signs of inflammation. In addition, LWIT was able to show that the normal control subjects without diagnosis of infection or signs of inflammation had relative temperature differentials of +1.1° C to 1.2° C. Finally, LWIT could detect adequate treatment of infected wounds with antibiotics as evidenced by a return to normal temperature differences gradient of +0.8° C to 1.1° C, as compared with normal control subjects with wounds in the same anatomical location. CONCLUSIONS: Long-wave infrared thermography can collect and record objective data, including relative temperature maximums associated with infection, inflammation, and normal healing wounds.

OBJECTIVE: To examine the prevalence of selected medical and psychiatric comorbidities that existed prior to or up to 10 years following traumatic brain injury (TBI) requiring acute rehabilitation. DESIGN: Retrospective cohort. SETTING: Six TBI Model Systems (TBIMS) centers. PARTICIPANTS: In total, 404 participants in the TBIMS National Database who experienced TBI 10 years prior. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Self-reported medical and psychiatric comorbidities and the onset time of each endorsed comorbidity. RESULTS: At 10 years postinjury, the most common comorbidities developing postinjury, in order, were back pain, depression, hypertension, anxiety, fractures, high blood cholesterol, sleep disorders, panic attacks, osteoarthritis, and diabetes. Comparing those 50 years and older to those younger than 50 years, diabetes (odds ratio [OR] = 3.54; P = .0016), high blood cholesterol (OR = 2.04; P = .0092), osteoarthritis (OR = 2.02; P = .0454), and hypertension (OR = 1.84; P = .0175) were significantly more prevalent in the older cohort while panic attacks (OR = 0.33; P = .0022) were significantly more prevalent in the younger cohort. No significant differences in prevalence rates between the older and younger cohorts were found for back pain, depression, anxiety, fractures, or sleep disorders. CONCLUSIONS: People with moderate-severe TBI experience other medical and mental health comorbidities during the long-term course of recovery and life after injury. The findings can inform further investigation into comorbidities associated with TBI and the role of medical care, surveillance, prevention, lifestyle, and healthy behaviors in potentially modifying their presence and/or prevalence over the life span.

Few studies look critically at the processes in a teacher education course in which students are asked to practice the very teaching approach they study. Using a constructivist framework, this article examines written statements from students working collaboratively in a graduate‐level class on cooperative learning. The study asks to what extent constructivist theory, particularly the concept of the zone of proximal development (ZPD), explains interactions that occurred spontaneously during group work on the final project. Content analysis was used to examine three types of writings: (a) dialogue journals, (b) self‐reports on the group process, and (c) self‐reports on each student's role in the group. Key findings address division of labor, role taking and switching, desire for challenge, power relationships, the languages used to express these concerns, and the need for social interaction to actualize constructivist claims.

This study was performed to determine whether there is a difference in nerve conduction study (NCS) measures based on body fat (body mass index; BMI). Two hundred fifty-three subjects had the following NCS tests performed on them: median, ulnar, peroneal, and tibial motor studies; median, ulnar, radial, and sural sensory studies; median and ulnar mixed nerve studies; and H-reflex studies. BMI was calculated as weight (kg) divided by height (m) squared. A repeated measures analysis of variance was run adjusting for age, sex, and height and using BMI as both a continuous variable and by dividing BMI into upper, middle, and lower thirds. The sensory and mixed nerve amplitudes correlated significantly (P < or = 0.01) with BMI for all nerves tested, with means being approximately 20-40% lower in the obese than in the thin subjects. No correlation was noted between BMI and nerve conduction velocity, H-reflex latency, or most of the other motor/sensory/mixed measures. The correlation between increased BMI and lower sensory/mixed nerve amplitudes should be taken into account in clinical practice.

Words associated with perceptually salient, highly imageable concepts are learned earlier in life, more accurately recalled, and more rapidly named than abstract words (R. W. Brown, 1976; Walker & Hulme, 1999). Theories accounting for this concreteness effect have focused exclusively on semantic properties of word referents. A novel possibility is that word structure may also contribute to the effect. We report a corpus-based analysis of the phonological and morphological structures of a large set of nouns with imageability ratings (N = 2,023). High- and low-imageability nouns differed by length, etymology, prosody, affixation, phonological neighborhood density, and rates of consonant clustering. On average, nouns denoting abstract concepts were longer, more derivationally complex, and emerged in English from a different distribution of languages than did concrete nouns. We address implications for interactivity of word form and meaning as pertain to theories of word concreteness, lexical acquisition, and word processing.

Background and Purpose- The amount of task-specific stepping practice provided during rehabilitation poststroke can influence locomotor recovery and reflects one aspect of exercise dose that can affect the efficacy of specific interventions. Emerging data suggest that markedly increasing the intensity and variability of stepping practice may also be critical, although such strategies are discouraged during traditional rehabilitation. The goal of this study was to determine the individual and combined contributions of intensity and variability of stepping practice to improving walking speed and distance in individuals poststroke. Methods- This phase 2, randomized, blinded assessor clinical trial was performed between May 2015 and November 2018. Individuals between 18 and 85 years old with hemiparesis poststroke of >6 months duration were recruited. Of the 152 individuals screened, 97 were randomly assigned to 1 of 3 training groups, with 90 completing >10 sessions. Interventions consisted of either high-intensity stepping (70%-80% heart rate reserve) of variable, difficult stepping tasks (high variable), high-intensity stepping performing only forward walking (high forward), and low-intensity stepping in variable contexts at 30% to 40% heart rate reserve (low variable). Participants received up to 30 sessions over 2 months, with testing at baseline, post-training, and a 3-month follow-up. Primary outcomes included walking speeds and timed distance, with secondary measures of dynamic balance, transfers, spatiotemporal kinematics, and metabolic measures. Results- All walking gains were significantly greater following either high-intensity group versus low-variable training (all P<0.001) with significant correlations with stepping amount and rate (r=0.48-60; P<0.01). Additional gains in spatiotemporal symmetry were observed with high-intensity training, and balance confidence increased only following high-variable training in individuals with severe impairments. Conclusions- High-intensity stepping training resulted in greater improvements in walking ability and gait symmetry than low-intensity training in individuals with chronic stroke, with potential greater improvements in balance confidence. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT02507466.

This study characterized life expectancy after traumatic brain injury (TBI). The TBI Model Systems (TBIMS) National Database (NDB) was weighted to represent those ≥16 years of age completing inpatient rehabilitation for TBI in the United States (US) between 2001 and 2010. Analyses included Standardized Mortality Ratios (SMRs), Cox regression, and life expectancy. The US mortality rates by age, sex, race, and cause of death for 2005 and 2010 were used for comparison purposes. Results indicated that a total of 1325 deaths occurred in the weighted cohort of 6913 individuals. Individuals with TBI were 2.23 times more likely to die than individuals of comparable age, sex, and race in the general population, with a reduced average life expectancy of 9 years. Independent risk factors for death were: older age, male gender, less-than-high school education, previously married at injury, not employed at injury, more recent year of injury, fall-related TBI, not discharged home after rehabilitation, less functional independence, and greater disability. Individuals with TBI were at greatest risk of death from seizures; accidental poisonings; sepsis; aspiration pneumonia; respiratory, mental/behavioral, or nervous system conditions; and other external causes of injury and poisoning, compared with individuals in the general population of similar age, gender, and race. This study confirms prior life expectancy study findings, and provides evidence that the TBIMS NDB is representative of the larger population of adults receiving inpatient rehabilitation for TBI in the US. There is an increased risk of death for individuals with TBI requiring inpatient rehabilitation.

BACKGROUND: Skeletal muscle atrophy is a common adaptation after spinal cord injury (SCI) that results in numerous health-related complications. Neuromuscular electrical stimulation (NMES) has been recognized as an effective tool, which attenuates atrophy and evokes hypertrophy. OBJECTIVE: To investigate the effects of NMES resistance training (RT) on individual muscle groups and adipose tissue of the right thigh after stimulation of the knee extensor muscle group in a man with chronic SCI. PARTICIPANT: A 22-year-old man with a complete SCI sustained in a motorcycle accident 5 years prior to participation in this study. METHODS: The participant underwent training twice a week for 12 weeks, including unilateral progressive RT of the right knee extensor muscle group using NMES and ankle weights. The stimulation was applied to knee extensors while the participant was sitting in his wheelchair. A series of T1-weighted magnetic resonance images were acquired for the whole right thigh prior to and after training. Skeletal muscle cross-sectional areas were measured of the whole thigh, knee extensors, hip adductors, hamstrings, and sartorius and gracilis muscle groups. Additionally, intramuscular fat and subcutaneous fat of the thigh were measured. RESULTS: At the end of 12 weeks, the participant was able to lift 17 lbs during full knee extension. Average skeletal muscle cross-sectional areas increased in all of the measured muscle groups (12%-43%). Hypertrophy ranging from 30% to 112% was detected in multiaxial slices after the NMES RT protocol. Intramuscular fat decreased by more than 50% and subcutaneous fat increased by 24%. CONCLUSION: Unilateral NMES RT protocol evoked hypertrophy in the knee extensor and adjacent skeletal muscle groups and was associated with a reduction in intramuscular fat in a person with a chronic SCI. Additionally, subcutaneous adipose tissue cross-sectional areas increased in response to RT.

The minicondylar plate fixation system is a new method for stable internal metaphyseal bone fixation about the metacarpophalangeal (MP) and proximal interphalangeal (PIP) joints. Indications for its use are rigid stabilization of fracture, osteotomy, and the bony components of composite tissue transfer. The device should be used in deference to other techniques when early active range of motion is pursued. Its best use is in the face of combined injury or osteotomy with tenolyses/capsulotomy. This implant permits stabilization of small epiphyseal fragments with minimal interference of joint function and perhaps a reduction of irritation of the extensor aponeurosis. Disadvantages include the need for careful preoperative planning because of this implant's small size and unforgiving tolerances of application. The data is included for the first 65 consecutive cases of its use. Despite the institution of range of motion therapy within five days in 77% of the cases, there were no nonunions. Two cases of delayed union were successfully treated by addition of cancellous bone grafts without revision of the fixation devices. Problems included malignments (three cases), infections (two cases), and soft tissue coverage (four cases). Aseptic necrosis of bone is associated with metacarpal head fractures and is seen with the use of this implant in treating such intraarticular fractures.

OBJECTIVES: To determine (1) alexithymia, affect recognition, and empathy differences in participants with and without traumatic brain injury (TBI); (2) the amount of affect recognition variance explained by alexithymia; and (3) the amount of empathy variance explained by alexithymia and affect recognition. PARTICIPANTS: Sixty adults with moderate-to-severe TBI; 60 age and gender-matched controls. PROCEDURES: Participants were evaluated for alexithymia (difficulty identifying feelings, difficulty describing feelings, and externally-oriented thinking); facial and vocal affect recognition; and affective and cognitive empathy (empathic concern and perspective-taking, respectively). RESULTS: Participants with TBI had significantly higher alexithymia; poorer facial and vocal affect recognition; and lower empathy scores. For TBI participants, facial and vocal affect recognition variances were significantly explained by alexithymia (12% and 8%, respectively); however, the majority of the variances were accounted for by externally-oriented thinking alone. Affect recognition and alexithymia significantly accounted for 16.5% of cognitive empathy. Again, the majority of the variance was primarily explained by externally-oriented thinking. Affect recognition and alexithymia did not explain affective empathy. CONCLUSIONS: Results suggest that people who have a tendency to avoid thinking about emotions (externally-oriented thinking) are more likely to have problems recognizing others' emotions and assuming others' points of view. Clinical implications are discussed.

This study examines the effect of amantadine on irritability in persons in the post-acute period after traumatic brain injury (TBI). There were 168 persons ≥6 months post-TBI with irritability who were enrolled in a parallel-group, randomized, double-blind, placebo-controlled trial receiving either amantadine 100 mg twice daily or equivalent placebo for 60 days. Subjects were assessed at baseline and days 28 (primary end-point) and 60 of treatment using observer-rated and participant-rated Neuropsychiatric Inventory (NPI-I) Most Problematic item (primary outcome), NPI Most Aberrant item, and NPI-I Distress Scores, as well as physician-rated Clinical Global Impressions (CGI) scale. Observer ratings between the two groups were not statistically significantly different at day 28 or 60; however, observers rated the majority in both groups as having improved at both intervals. Participant ratings for day 60 demonstrated improvements in both groups with greater improvement in the amantadine group on NPI-I Most Problematic (p<0.04) and NPI-I Distress (p<0.04). These results were not significant with correction for multiple comparisons. CGI demonstrated greater improvement for amantadine than the placebo group (p<0.04). Adverse event occurrence did not differ between the two groups. While observers in both groups reported large improvements, significant group differences were not found for the primary outcome (observer ratings) at either day 28 or 60. This large placebo or nonspecific effect may have masked detection of a treatment effect. The result of this study of amantadine 100 mg every morning and noon to reduce irritability was not positive from the observer perspective, although there are indications of improvement at day 60 from the perspective of persons with TBI and clinicians that may warrant further investigation.

OBJECTIVES: To examine the acceptability and initial efficacy of an emotional self-awareness treatment at reducing alexithymia and emotion dysregulation in participants with traumatic brain injury (TBI). SETTING: An outpatient rehabilitation hospital. PARTICIPANTS: Seventeen adults with moderate to severe TBI and alexithymia. Time postinjury ranged 1 to 33 years. DESIGN: Within subject design, with 3 assessment times: baseline, posttest, and 2-month follow-up. INTERVENTION: Eight lessons incorporated psychoeducational information and skill-building exercises teaching emotional vocabulary, labeling, and differentiating self-emotions; interoceptive awareness; and distinguishing emotions from thoughts, actions, and sensations. MEASURES: Toronto Alexithymia Scale-20 (TAS-20); Levels of Emotional Awareness Scale (LEAS); Trait Anxiety Inventory (TAI); Patient Health Questionnaire-9 (PHQ-9); State-Trait Anger Expression Inventory (STAXI); Difficulty With Emotion Regulation Scale (DERS); and Positive and Negative Affect Scale (PANAS). RESULTS: Thirteen participants completed the treatment. Repeated-measures analysis of variance revealed changes on the TAS-20 (P = .003), LEAS (P < .001), TAI (P = .014), STAXI (P = .015), DERS (P = .020), and positive affect (P < .005). Paired t tests indicated significant baseline to posttest improvements on these measures. Gains were maintained at follow-up for the TAS, LEAS, and positive affect. Treatment satisfaction was high. CONCLUSION: This is the first study published on treating alexithymia post-TBI. Positive changes were identified for emotional self-awareness and emotion regulation; some changes were maintained several months posttreatment. Findings justify advancing to the next investigational phase for this novel intervention.

Data on traumatic brain injury (TBI) economic outcomes are limited. We used Rochester Epidemiology Project (REP) resources to estimate long-term medical costs for clinically-confirmed incident TBI across the full range of severity after controlling for pre-existing conditions and co-occurring injuries. All Olmsted County, Minnesota, residents with diagnoses indicative of potential TBI from 1985-2000 (n=46,114) were identified, and a random sample (n=7175) was selected for medical record review to confirm case status, and to characterize as definite (moderate/severe), probable (mild), or possible (symptomatic) TBI. For each case, we identified one age- and sex-matched non-TBI control registered in REP in the same year (±1 year) as case's TBI. Cases with co-occurring non-head injuries were assessed for non-head-injury severity and assigned similar non-head-injury-severity controls. The 1145 case/control pairs for 1988-2000 were followed until earliest death/emigration of either member for medical costs 12 months before and up to 6 years after baseline (i.e., injury date for cases and comparable dates for controls). Differences between case and control costs were stratified by TBI severity, as defined by evidence of brain injury; comparisons used Wilcoxon signed-rank plus multivariate modeling (adjusted for pre-baseline characteristics). From baseline until 6 years, each TBI category exhibited significant incremental costs. For definite and probable TBI, most incremental costs occurred within the first 6 months; significant long-term incremental medical costs were not apparent among 1-year survivors. By contrast, cost differences between possible TBI cases and controls were not as great within the first 6 months, but were substantial among 1-year survivors. Although mean incremental costs were highest for definite cases, probable and possible cases accounted for>90% of all TBI events and 66% of total incremental costs. Preventing probable and possible events might facilitate substantial reductions in TBI-associated medical care costs.

At the center for Rehabilitation of Brain Damage, University of Copenhagen, 46 consecutively admitted brain-damaged patients with varying pathologies and who were on average 2.9 years post-injury were treated in a daily four-month rehabilitation program in groups of about 10, followed by a six-month period of contact varying according to individual needs. An evaluation of psychosocial outcome is presented. The results, based on comparisons between pre-, post-treatment and follow-up questionnaire data, show continuing functional improvements in the areas of family life and living conditions. Dependence on health services declined. Over 70% of the patients returned to either work, further education or voluntary work activities. For the whole group, leisure activities returned to the pre-injury level. Follow-up at about two years revealed continuing improvements in all areas, suggesting social readaptation to a degree above expectations as judged from the existing literature.

OBJECTIVE: We assessed the prevalence of fear of falling (FoF) in a sample of people with chronic stroke and compared multiple variables (balance, anxiety, depression, activity and participation, and stroke severity) in people with and without FoF. METHOD: This study was a secondary analysis of data collected from a cross-sectional study of mobility after stroke in 77 participants with chronic stroke (>6 mo poststroke). RESULTS: Of the 77 participants, 51 (66%) reported experiencing FoF. People with FoF had significantly decreased balance (p<.001) and activity and participation (p=.006) and significantly increased anxiety (p=.007). People with FoF also had significantly worse stroke severity (p=.001). CONCLUSION: FoF is a prevalent concern in the chronic stroke population. The presence of FoF was associated with a variety of negative consequences. Occupational therapy practitioners should address FoF to help clients manage FoF and possibly improve recovery.

Depression and suicide are two major mental health problems affecting older adults, this country's fastest growing population. As such, more nurses must become educated on assessing their geriatric patients for the signs and symptoms of each. These subjects are very difficult to breach and often are not discussed unless rapport has been established through nurses' use of positive, therapeutic communication. When confronted, professional nurses are placed in the difficult situation between maintaining the patient's privacy or confidentiality, respecting their federally protected health information, and the duty to care for the patient. Open discussion between the nurse and other members of the treatment team is vital to identifying the issue and providing older patients with the mental health care they require.

OBJECTIVE: This study utilized the Traumatic Brain Injury Model Systems (TBIMS) National Database to examine the prevalence of depression and suicidal behaviour in a large cohort of patients who sustained moderate-to-severe TBI. METHOD: Participants presented to a TBIMS acute care hospital within 72 hours of injury and received acute care and comprehensive rehabilitation in a TBIMS designated brain injury inpatient rehabilitation programme. Depression and suicidal ideation were measured with the Patient Health Questionnaire (PHQ-9). Self-reported suicide attempts during the past year were recorded at each follow-up examination, at 1, 2, 3, 10, 15 and 20 years post-injury. RESULTS: Throughout the 20 years of follow-up, rates of depression ranged from 24.8-28.1%, suicidal ideation ranged from 7.0-10.1% and suicide attempts (past year) ranged from 0.8-1.7%. Participants who endorsed depression and/or suicidal behaviour at year 1 demonstrated consistently elevated rates of depression and suicidal behaviour 5 years after TBI. CONCLUSION: Compared to the general population, individuals with TBI are at greater risk for depression and suicidal behaviour many years after TBI. The significant psychiatric symptoms evidenced by individuals with TBI highlight the need for routine screening and mental health treatment in this population.

PURPOSE: The purpose of this study was to perform an evidence-based, expert consensus survey using the Delphi panel methodology to develop recommendations for the treatment of degenerative meniscus tears. METHODS: Twenty panel members were asked to respond to 10 open-ended questions in rounds 1 and 2. The results of the first 2 rounds served to develop a Likert-style questionnaire for round 3. In round 4, the panel members outside consensus were contacted and asked to either change their score in view of the group's response or argue their case. The level of agreement for round 4 was defined as 80%. RESULTS: There was 100% agreement on the following items: insidious onset, physiological part of aging, tears often multiplanar, not all tears cause symptoms, outcomes depend on degree of osteoarthritis, obesity is a predictor of poor outcome, and younger patients (<50 years) have better outcomes. There was between 90% and 100% agreement on the following items: tears are nontraumatic, radiographs should be weightbearing, initial treatment should be conservative, platelet-rich plasma is not a good option, repairable and peripheral tears should be repaired, microfracture is not a good option for chondral defects, the majority of patients obtain significant improvement and decrease in pain with surgery but results are variable, short-term symptoms have better outcomes, and malalignment and root tears have poor outcomes. CONCLUSIONS: This consensus statement agreed that degenerative meniscus tears are a normal part of aging. Not all tears cause symptoms and, when symptomatic, they should initially be treated nonoperatively. Repairable tears should be repaired. The outcome of arthroscopic partial meniscectomy depends on the degree of osteoarthritis, the character of the meniscus lesion, the degree of loss of joint space, the amount of malalignment, and obesity. The majority of patients had significant improvement, but younger patients and patients with short-term symptoms have better outcomes. LEVEL OF EVIDENCE: Level V - expert opinion.