JRRD at a Glance

Physical and mental health issues are challenging for many veterans. We studied the use of extended group-based nature recreation to help veterans cope with these issues. Veterans were surveyed 1 week before, 1 week after, and about 1 month after partici- pating in an outdoor recreation program. Participants reported increased psychological well-being, social functioning, and life outlook 1 week after the expe- rience and some improvements persisted over the next month. These changes were particularly strong for veterans reporting more severe ongoing health issues. Findings suggest that extended nature rec- reation experiences that bring veterans together can have significant positive effects.

http://dx.doi.org/10.1682/JRRD.2013.08.0190

Glasgow Coma Scale scores, early opioids, and 4-year psychological outcomes among combat amputees

Ted Melcer, PhD, et al.

Previous research showed that combat amputees were less likely to develop posttraumatic stress dis- order (PTSD) than nonamputees. We tested the pos- sibility that loss of consciousness or provision of pain medicine (morphine or fentanyl) soon after injury might prevent PTSD. We followed psychological diag- noses in military and Department of Veterans Affairs hospital records for 258 combat amputees for 4 years. PTSD was less likely for patients treated with mor- phine than for patients treated with fentanyl, but only for 2 years after injury. Overall, PTSD cases increased over the first 4 years after injury, compared with other psychological diagnoses, such as depression.

http://dx.doi.org/10.1682/JRRD.2013.06.0143

Design and evaluation of prosthetic shoulder controller

Joseph E. Barton, PhD; John D. Sorkin, MD, PhD

The human humerus possesses three degrees of freedom (DOFs) with respect to the glenohumeral joint: flexion-extension, abduction-adduction, and internal-external rotation. Artificial limbs made for people who have lost their anatomical arm at or near the shoulder have historically not been able to per- form these motions, greatly limiting their usefulness to people with amputation. We developed a proto- type that uses the motion of the sternoclavicular joint along its two DOFs (protraction-retraction and elevation-depression) to produce signals that can be used to control two of a prosthetic humerus' DOFs, as well as an evaluation protocol to assess the perfor- mance of a prosthetic arm in reaching and pointing tasks.

http://dx.doi.org/10.1682/JRRD.2013.05.0120

Canadian Occupational Performance Measure performance scale: Validity and responsiveness in chronic pain

Mieke G. Nieuwenhuizen, MSc, PT, et al.

The Canadian Occupational Performance Meas- ure (COPM) is a generic, individualized, patient- centered outcome measure and might be of aid to enhance communication about problems in partici- pation and for goal setting in rehabilitation in any population. Therefore, this instrument can be of use in Department of Veterans Affairs rehabilitation as well. We have investigated the validity and respon- siveness of this instrument in a broad population of patients with chronic pain in whom psychological factors are important maintaining factors. Chronic pain and psychological suffering are more prevalent in veterans, and our results might be applicable for this population. In our study, construct validity of the COPM performance scale was not confirmed. No in- dication was found that the COPM performance scale can detect changes in occupational performance.

http://dx.doi.org/10.1682/JRRD.2012.12.0221

Feasibility of closed-loop controller for righting seated posture after spinal cord injury

Julie O. Murphy, BSE,, et al.

Paralysis of the hip and trunk muscles after spi- nal cord injury can compromise the ability to main- tain an upright sitting posture. This study determined the performance of a system that detected forward trunk tilt and stimulated the hip and trunk extensors to restore erect sitting automatically. The controller enabled users to lean forward and return with signifi- cantly less effort than with no stimulation. This re- search is important for many paralyzed veterans who would otherwise be unable to reach forward with both hands or who rely on straps or belts to prevent falling forward in their wheelchairs.

http://dx.doi.org/10.1682/JRRD.2013.09.0200

Stability analysis of electrical powered wheelchair- mounted robotic-assisted transfer device

Hongwu Wang, PhD, et al.

The ability of people with disabilities to live in their homes and communities with maximal inde- pendence often hinges, at least in part, on their ability to transfer or be transferred by an assistant. An easy- to-use system for assisting with transfers, attachable to electrical powered wheelchairs (EPWs) and readily transportable, could have a significant positive effect on the quality of life of people with disabilities. This study investigated the stability of our newly devel- oped Strong Arm, which is attached and integrated with an EPW to assist with transfers. The stability of the system was analyzed and verified by experiments applying different loads and using different system configurations. Our modeling accurately predicts the stability of the system and is suitable for developing better control algorithms to enhance the safety of the device.

http://dx.doi.org/10.1682/JRRD.2013.11.0240

Development of intelligent model for personalized guidance on wheelchair tilt and recline usage for people with spinal cord injury: Methodology and preliminary report

Jicheng Fu, PhD, et al.

Veterans with spinal cord injury (SCI) are at great risk for pressure ulcers because of their prolonged stays in wheelchairs. Wheelchair tilt and recline functions are two of the most desirable features for relieving seating pressure to reduce risk of pressure ulcers. In this study, we demonstrated the feasibility of using machine learning techniques to construct an intelligent model to provide personalized guidance on wheelchair tilt and recline usage for people with SCI. Our intelligent model considers individuals' de- mographic, neurological, and SCI injury attributes. Veterans with SCI may benefit from this intelligent model for selecting suitable tilt and recline settings.

http://dx.doi.org/10.1682/JRRD.2013.09.0199

Pushrim biomechanical changes with progressive increases in slope during motorized treadmill manual wheelchair propulsion in individuals with spinal cord injury

Dany H. Gagnon, PT, PhD, et al.

The use of a motorized treadmill to assess and train manual wheelchair propulsion has gained great popularity over the past few years. Little is known about the effects of increasing the slope on the force applied at the pushrim. This study assessed the ef- fects of five different slopes on the force applied with the nondominant hand on the pushrim during manual wheelchair propulsion on a motorized treadmill at a constant speed in individuals with a spinal cord injury. In general, these individuals grabbed their pushrim faster with their hand between strokes and applied greater forces on the pushrim as the slope of the treadmill increased during manual wheelchair propulsion.

http://dx.doi.org/10.1682/JRRD.2013.07.0168

Passive prosthetic ankle-foot mechanism for automatic adaptation to sloped surfaces

Eric Nickel, MS, et al.

Persons with amputation of a leg often have dif- ficulty walking on sloped or uneven surfaces. Some microprocessor-controlled prosthetic ankle-foot sys- tems are able to adapt their alignment to a surface slope over several steps, but a better system would be capable of adapting fully on every step without bat- teries and electronic systems. This article describes the development and initial testing of a passive me- chanical prosthetic ankle-foot system designed to automatically adjust its alignment on every step of walking.

http://dx.doi.org/10.1682/JRRD.2013.08.0177

Effect of low-intensity direct current on expression of vascular endothelial growth factor and nitric oxide in diabetic foot ulcers

Mohammad Reza Mohajeri-Tehrani, MD, et al.

Diabetic foot ulceration is an important compli- cation of diabetes. These ulcers are long-lasting open sores that are hard to heal because of poor blood circulation at the wound site. We studied how electri- cal stimulation affected levels of vascular endothelial growth factor and nitric oxide in the plasma of type 2 diabetic patients with foot ulceration. Electrical stimu- lation was delivered for 1 hour a day, 3 days a week, for 4 weeks (12 sessions total). Vascular endothelial growth factor and nitric oxide levels were significantly higher after the 12 sessions in the group who received electrical stimulation compared with an untreated group. Skin temperature increased significantly more in the electrical stimulation group than the untreated group. Application of electrical stimulation increases the expression of vascular endothelial growth factor and nitric oxide, which may improve blood flow, tis- sue temperature, and wound healing in patients with diabetic foot ulceration.

http://dx.doi.org/10.1682/JRRD.2013.08.0174

Extraction of spatial information for low- bandwidth telerehabilitation applications

Kok Kiong Tan, PhD, et al.

We developed a method for extracting spatial data from a 2-dimensional video screen to substitute for 3-dimensional requirements in a low-bandwidth telerehabilitation system. This could help whenever spatial resolution is required in a consultation ses- sion, because 3-dimensional video files are often too large to transmit. We used Microsoft's Kinect to- gether with color detection algorithms to extract the depth information of the human body parts. No sen- sors need to be attached to the body for successful implementation of this system.

http://dx.doi.org/10.1682/JRRD.2013.09.0217

Intrinsic transient tracheal occlusion training and myogenic remodeling of rodent parasternal intercostal fibers

Barbara K. Smith, PhD, PT, et al.

This research has clinical implications for pa- tients with weak respiratory muscles and dyspnea (shortness of breath). A rat model was used to identify fiber hypertrophy and regeneration in the parasternal intercostal muscles after 2 weeks of respiratory mus- cle training. The exercises increased parasternal fiber size equally and regeneration to a greater extent than the diaphragm. This work adds to our understanding of the cellular mechanisms by which respiratory mus- cle training improves muscle function. These findings may help providers prescribe to their patients the best type, frequency, and duration of exercise to improve inspiratory muscle function.

http://dx.doi.org/10.1682/JRRD.2012.12.0232