Roger C. Peace Rehabilitation Hospital

Thirty people with classical or definite rheumatoid arthritis received laser exposure to a Q-switch neodymium laser that operated at 1.06 micrometer with an output of 15 joules/cm2 for 30 nsec. One hand was lased at the proximal interphalangeal (PIP) and metacarpal phalangeal (MCP) joints, whereas the other hand was sham lased. The patient, physician, and occupational therapy evaluators did not know which hand was being lased. Twenty-one patients noted improvement of both their MCP and PIP joints of both hands during laser therapy. Twenty-seven noted improvement of their PIP joints and 26 noted improvement of the MCP joints during therapy. Heat, erythema, pain, swelling, and tenderness all improved with time in both hands, but the lased hand had more significant improvement in erythema and pain. There was also significant improvement in grasp and tip pressure on the lased side. The level of circulating immune complexes as measured by platelet aggregation decreased during lasing. The improvement may be related to laser exposure. The exact role that laser radiation has upon rheumatoid arthritis and its mechanism of action remain to be elucidated.

OBJECTIVE: To examine a subgroup of severely injured patients spending > or = 3 weeks in the intensive care unit (ICU) and to determine their disposition and eventual functional outcome. METHODS: A retrospective review of our trauma registry and medical records over a 7-year period (January of 1991 to December of 1997) identified 115 patients with ICU length of stay (LOS) > or = 3 weeks. Variables selected included age, length of stay, injury severity score, injuries, disposition, and charges. Functional independence measures (FIM) were obtained in patients requiring inpatient rehabilitation and a written questionnaire (Rand 36-item Health Survey) was mailed to all patients alive at discharge. RESULTS: Mean ICU length of stay of the 115 patients was 36 days (range, 21-106 days); mean age, 49 years (range, 4-89 years); 73 patients (63%) were males, 42 patients (37%) were females. Overall mortality was 22% (n = 25). The remaining 90 patients survived to discharge with the following disposition: rehabilitation facility 60% (n = 54), home with temporary disability 22% (n = 20), nursing home 8% (n = 7), home with permanent disability 4% (n = 4), transferred 6% (n = 5). Mean hospital charge was $193,000 (range, $77,000-$528,000). No variable or combination could predict outcome except age. Elderly patients (age > or = 75, n = 24) had an overall mortality of 42% (n = 10). Eight of 14 survivors fulfilled admission criteria and entered our rehabilitation facility. The remaining six elderly patients either went to nursing homes or were permanently disabled. Complete FIM scores were available on 47 of 54 patients who went to rehabilitation facility. The mean rehabilitation facility admission FIM score was 52, indicating either complete dependence or the need for moderate assistance. After they had remained at the rehabilitation facility for a mean of 48 days (range, 7-278 days), patients' FIM scores improved to a mean of 86, signifying minimal contact assistance or supervision only. Three-month follow-up FIM scores continued to improve to a mean of 101, a score denoting complete independence. Elderly patients within the rehabilitation facility fared as well as the younger group. For the Rand-36 survey, 47 of 90 patients or family members were contacted. Twelve patients died since discharge, leaving 35 patients to complete the survey. Despite excellent FIM scores, overall mean health was only fair to good, with limitations to activity and lack of energy cited as the main problems. CONCLUSION: Despite tremendous resource utilization, the majority of trauma patients with prolonged ICU stays can eventually return to varying degrees of functional daily living and independence, but not to preinjury levels. A subgroup of severely injured elderly patients had a significantly higher mortality rate. However, elderly survivors that entered our rehabilitation facility fared as well as the younger patients.

Abstract Occupational therapists are constantly searching for engaging, high-technology interactive tasks that provide immediate feedback to evaluate and train clients with visual scanning deficits. This study examined the relationship between two tools: the VISION COACH™ interactive light board and the Functional Object Detection© (FOD) Advanced driving simulator scenario. Fifty-four healthy drivers, ages 21–66 yr, were divided into three age groups. Participants performed braking response and visual target (E) detection tasks of the FOD Advanced driving scenario, followed by two sets of three trials using the VISION COACH Full Field 60 task. Results showed no significant effect of age on FOD Advanced performance but a significant effect of age on VISION COACH performance. Correlations showed that participants’ performance on both braking and E detection tasks were significantly positively correlated with performance on the VISION COACH (.37 < r < .40, p < .01). These tools provide new options for therapists.

OBJECTIVE: Two studies were conducted to obtain an understanding of the types of items seniors keep in their nightstands and to understand how users feel about the possibility of "smart" furniture. BACKGROUND: To enable aging in place and universal design, it is vital to understand the needs of a broad range of aging individuals, especially since there is little research on nightstand usage and design. METHODS: Study 1 allowed for the development of a structured inventory of nightstand use today in assisted living and rehabilitation facilities. Study 1 led to Study 2, demonstrating the need to conceptualize new ideas for smart nightstands. Feedback was obtained from intergenerational participants who could discuss their needs and preferences for a smart nightstand. RESULTS: In Study 1, more than 150 items were recorded and categorized into 25 different groups. The authors found that participants utilized the top portion of their nightstand as opposed to the lower sections; most items were found on top of the nightstand or in the top drawer. In Study 2, the authors found that the vast majority of participants are willing to consider the use of a smart nightstand. Participants discussed key functions and design preferences, which included carefully designed storage, the ability to move the nightstand up and down, contemporary design, and interaction through voice activation. CONCLUSION: Existing nightstands do not meet the needs of current users. This research provides greater understanding of the existing limitations associated with nightstands. Study 2 confirmed that user-centered design and the use of technology can be used to enhance daily living. Smart furniture may play a role in promoting the health and independence of diverse user groups.

To investigate the use and potential for patient acceptance of the DrivingHealth(®) Inventory (DHI) in clinical practice, we administered the DHI to 360 community dwelling volunteers over age 50 at a Southeastern US rehabilitation hospital. Volunteers also completed surveys to document their health, driving habits, and impressions of the DHI. Volunteers reported strong agreement with statements that indicated that they believe the DHI measures abilities important for safe driving and that they would be willing to listen to advice about driving and safe mobility from medical professionals; however, responses to some items were more positive among drivers whose DHI results indicated no apparent loss of function that could impair driving. These results support the use of the DHI in clinical practice as a tool to raise awareness of factors that correlate to driving; however, further research will be necessary to investigate how the DHI may benefit diverse clinical populations. Experiences with using DHI as part of clinical practice are also discussed.

ABSTRACT Interactive driving simulators may offer a safe and controlled environment for occupational therapists to treat clients with conditions that affect their ability to drive safely. The use of simulators has been mostly limited to research settings. To make appropriate use of this technology, identifying and understanding the needs of clients and medical personnel that simulators can fulfill is important. The current investigation seeks to identify the attitudes of potential clients and physicians regarding the use of driving simulators. Using survey and interview methodology, clients' and physicians' needs in regard to driving and community mobility are investigated in the context of identifying potential applications for simulator technology. In addition, general needs and attitudes about driving in the context of medical practice were identified. Attitudes toward the use of simulators were generally positive, and the desire for a greater ability to understand and treat clients in the context of driving appears strong.

This article discusses autonomic dysreflexia, which can occur in patients with spinal cord injury. This potentially life-threatening complication can be managed through an understanding of the disorder and its primary causes. The primary cause of this problem is usually a noxious stimuli that precipitates an abnormal response from the autonomic nervous system. Prevention is the primary nursing treatment and includes implementation of a bladder and bowel management program early in the treatment of the patient with spinal cord injury.

The VISION COACH™ interactive light board is designed to test and enhance participants' psychomotor skills. The primary goal of this study was to examine the test-retest reliability of the Full Field 120 VISION COACH task. One hundred eleven male and 131 female adult participants completed six trials where they responded to 120 randomly distributed lights displayed on the VISION COACH interactive light board. The mean time required for a participant to complete a trial was 101 seconds. Intraclass correlation coefficients, ranging from 0.962 to 0.987 suggest the VISION COACH Full Field 120 task was a reliable task. Cohen's d's of adjacent pairs of trials suggest learning effects did not negatively affect reliability after the third trial.

OBJECTIVE: Multiple user groups (patients and employees at a rehabilitation facility, community-dwelling seniors, and university students) participated in a study that examined their preferences for the features and functions of three novel nightstand prototypes. BACKGROUND: It is valuable to get input from different user groups in order to improve furniture usefulness and usability, especially furniture prevalent in clinical settings where users of all age groups are found. METHODS: Feedback was obtained from different user groups in both clinical (rehabilitation facility) and nonclinical (university) settings. This was done using structured interviews to ask participants about multiple features of the novel nightstand designs. RESULTS: There were several features that all groups preferred. There were also some distinctly opposing opinions between groups. In general, the patient group showed the most similarities to the other groups. CONCLUSION: This research explores differences and similarities in preferences for nightstand design across a variety of user groups. It yields ideas for improving the nightstand design to be useful for a wider group of people.

OBJECTIVE: This article presents the results of an exploratory study in which 14 healthcare subject matter experts (H-SMEs) in addition to four research and design subject matter experts (RD-SMEs) at a regional rehabilitation hospital engaged in a series of complementary, participatory activities in order to design an assistive robotic table (ART). BACKGROUND: As designers, human factor experts, and healthcare professionals continue to work to integrate assistive human-robot technologies in healthcare, it is imperative to understand how the technology affects patient care from clinicians' perspectives. METHOD: Fourteen clinical H-SMEs rated a subset of conceptual ART design ideas; participated in the iterative design process of ART; and evaluated a final cardboard prototype, the rehabilitation hospital's current over-the-bed table (OBT), an ART built with true materials, and two therapy surface prototypes. Four RD-SMEs conducted a heuristic evaluation on the ART built with true materials. Data were analyzed by frequency and content analysis. RESULTS: The results include a design and prototype for the next generation ART and a pneumatically controlled therapy surface, a broadened list of specifications for the future design and implementation of assistive robotic furniture, and final observations. CONCLUSION: When compared to the rehabilitation hospital's current OBT, the developed ART in this study was successful. Designing novel features is dependent upon ensuring patient safety. The inclusion of clinicians in the participatory iterative design and evaluation process and the use of personas provided a broadened list of specifications for the successful implementation of assistive robotic furniture.

OBJECTIVE: To introduce New2Neuropsychology (N2N), an organization that seeks to increase recruitment of historically underrepresented minoritized (URM) students, and to examine preliminary data on N2N's impact and effectiveness in increasing knowledge about neuropsychology for URM students. METHOD: This paper reviews relevant literature on factors informing the development of N2N. We also present descriptive data on N2N's impact to date, and results of pre- and post- surveys for presentations about neuropsychology delivered to 90 college students (mean age = 24.23, 64.4% juniors or seniors) between November 2021 - March 2023. RESULTS: = 0.36). CONCLUSIONS: To date, N2N has progressed toward its goal, showing preliminary success increasing knowledge about neuropsychology for URM students. With continued development and support, N2N seeks to transform the pathway to neuropsychology for URM students, expanding accessibility of N2N resources across diverse groups and connecting URM students to neuropsychology research and clinical experiences.

Abstract Neuropsychological data from men and women with lateralized cerebral lesions were compared to determine whether evidence of differential cognitive lateralization according to sex could be found. Previous evaluation of IQ data from these same groups failed to support a differential lateralization theory (Herring & Reitan, 1986). Subjects included 48 adults with independent neurological evidence of neoplastic or vascular lesions of the right cerebral hemisphere, 48 adults with evidence of left cerebral hemisphere lesions, and 28 controls. Each group had equal numbers of men and women and were composed for equivalence regarding age, education, lesion site, severity, chronicity, and etiology. Subjects were administered a battery of neuropsychological tests. The results yielded some evidence of female superiority in verbal functioning, but neither sex performed better than the other on any single dependent variable. Results of multivariate and univariate analyses failed to support any Sex × Lesioned Hemisphere interaction. The study also examines whether existing sex differences justify sex specific norms on these measures.

<div class="section abstract"><div class="htmlview paragraph">The ability to independently transfer into and out of a vehicle is essential for many wheelchair users to achieve driving independence. This paper presents the results of an exploratory study that investigated the transfer strategies of wheelchair users who drive from their driver’s seat and not from their wheelchair. The goal of this study was to identify typical ingress and egress motions as well as “touch points” of wheelchair users transferring into and out of the driver’s seat. While motion databases exist for the ingress and egress of able-bodied drivers, this study provides insight on drivers with physical disabilities. Twenty-five YouTube videos of wheelchair users who transferred into and out of their own sedans were analyzed. The locations where the drivers’ hands, feet, and hips interacted with the vehicle, as well as the actions of the drivers while transferring from their wheelchair into the driver’s seat and then transferring from the driver’s seat into their wheelchair were recorded. Action sequences and wheelchair and vehicle touch points were plotted in CAD. Results indicate that drivers tend to transfer using one of two primary techniques, hand-first or foot-first, and that clusters of touch points are mainly found on the driver’s seat and the steering wheel of the vehicle. The strategies used and touch point locations for ingress and egress were very similar. Knowledge gained in this study may impact future vehicle design, making vehicles easier to access for drivers with and without disabilities.</div></div>

This article proposes that the use of art with a stroke group is an excellent method of facilitating communication. Most stroke patients, whether right or left hemiplegics, can participate in this form of group therapy. Participants and group leaders find it to be a rewarding method of communication. While stroke patients express physical goals with therapists, their emotional goals may often be overlooked. Art projects allow stroke patients to express expectations, goals and feelings regarding themselves, their families, friends, and environmental needs. Patients also express feelings about the rehabilitation program and their adjustment to policies and procedures. Art therapy is a method of data assessment useful in planning rehabilitative goals with the patient and family.

Collaboration and communication are key to successful teamwork that results in positive patient outcomes. This article shares the journey of one rehabilitation hospital to improve collaboration and teamwork among the nursing and therapy staff. A year-long series of staff retreats focused on improving interprofessional communication proved successful, resulting in the revitalization of an interdisciplinary unit council.

Understanding unique perspectives from key stakeholder groups involved in the hand control (HC) industry, including driver rehabilitation specialists (DRSs) who train users how to use their HCs, dealers/installers, and users, may become increasingly important in the United States due to increases in elderly, diabetic, and wounded warrior amputee driving populations. In this exploratory study, phone interviews were conducted with 20 DRSs, 20 dealers/installers, and 20 users regarding their perspectives about HC training, maintenance and operation, and design improvements. Results revealed common views and differences in perspectives about whether HC users should receive training and for how long, when and how often users should receive maintenance on their HCs, and what DRSs, dealers/installers, and users would like to see in the future.

Persons with spinal cord injury (SCI) are at an increased risk of physiological morbidity compared to their ambulatory counterparts in whom well-established, beneficial correlations exist between exercise, cardiorespiratory health and body composition. Furthermore, SCI who participate in sport may have reduced risk of physiological morbidity than SCI who are sedentary. PURPOSE: This pilot study was two-fold: 1) to determine whether differences exist in cardiorespiratory health and body composition between SCI athletes (ATHL) and sedentary SCI (SED), and 2) to determine whether an 8-week handcycle exercise training program is feasible in an SED SCI population, and if improvements in cardiorespiratory fitness and body composition occur. METHODS: Twenty-seven SED and six ATHL were recruited to participate in the study. All SCI completed a graded hand cycling maximal exercise test for cardiorespiratory fitness (VO2max) and body composition testing (iDEXA). SED participants were then randomized into a virtual reality intervention (VR) or waitlist (WL) group (e.g. offered VR after 8 weeks of WL). The intervention consisted of an 8-week community-based VR group hand cycling exercise training with a USA level 1 coach two days/week. Pre-post outcomes were measured in each group. RESULTS: Thirty-three SCI were recruited to participate (SED n=27; ATHL n=6). All ATHL and 17 SED participants (VR=9, WL=8) completed study protocol, with 10 (VR=1 and WL=9) lost to follow up. One participant was dropped from analysis due to not giving a full effort during testing as determined by investigators. ATHL had 23 physiological and anthropometric variables that were significantly different (p≤0.01) compared to SED including higher VO2max (19.1 ml/kg/min), lower BMI (-4.6 kg/m2), and lower total body fat percentage (-10.4%). VO2max increased 16% in VR and 9% in WL, which was not statistically different. CONCLUSION: This study demonstrates the feasibility of a hand cycling program in SCI. ATHL had better outcomes associated with long term health compared to their SED counterparts. Though no significant changes were noted in VR compared to WL, changes in VO2max may be clinically relevant. A larger sample size or longer training period may be needed to observe significant differences in physiological health in an SED SCI population.

INTRODUCTION: Neuropsychology has historically lacked inclusion of trainees and professionals from underrepresented minoritized (URM) backgrounds. Recruitment and retention of students from diverse backgrounds is critical to improving the quality of neuropsychology practice and science, ensuring ongoing accessibility and maintaining relevance in the healthcare marketplace. New2Neuropsychology (N2N) has hosted Meet & Learn networking events to address this pathway problem. The current study aimed to (1) examine the impact of these events on students' knowledge and interest in neuropsychology, (2) explore perceived barriers to pursuing a career in neuropsychology, and (3) compare findings between N2N networking events and educational presentations. METHOD: = 25; 77% female; 77% belonged to a URM group; 45% fifth year undergraduate or post-baccalaureate). A sample of 48 attendees completed both pre- and post-event surveys. One-way ANOVA and t-tests examined the study aims. RESULTS: Networking event attendees reported increased knowledge about the field and confidence in their ability to become a neuropsychologist. Fifth year undergraduate students and post-baccalaureates reported an increase in their likelihood of pursuing neuropsychology following the event relative to upper- and underclassmen, though, with no differences among students with or without a URM background. Students who attended the networking events were more interested in pursuing neuropsychology at baseline compared to students who attended the educational presentations, while students who attended educational presentations reported learning more about the field after the presentation. Finances were identified as the primary barrier to pursuing a career in neuropsychology at both types of events. CONCLUSIONS: Findings provide preliminary support for the positive impact of N2N networking event programming and highlight areas for organizational development, including capturing students across interest groups and training stages, financial support and connection to training opportunities, and incorporation of qualitative and longitudinal data.

Roger C. Peace Rehabilitation Hospital, Greenville Hospital System, 701 Grove Road, Greenville, SC 29605. Maria J. Glenn is director of nursing at Roger C. Peace Rehabilitation Hospital, a division of the Greenville Hospital System, in Greenville, SC. Department Editor Director of Nursing

North American Brain Injury Society's Sixth Annual Conference on Brain Injury: October 2–4, 2008, New Orleans, Louisiana: Abstract