Dec. 15, 2003 The current issue of the Journal of Rehabilitation Research and Development (JRRD), a publication of Rehabilitation Research and Development, Department of Veterans Affairs (VA), includes articles discussing the impact of functional electrical stimulation on patients with spinal cord injury (SCI) and muscle weakness. Also in this issue are articles that report on exercise for people with SCI, how weight impacts foot shape, orthotic selection, and the graying of family heathcare providers for individuals with disabilities.
Also published with Volume 40 Issue 6 of JRRD is a compendium of abstracts from the Tenth International Symposium On Neural Regeneration held in Pacific Grove, California, December 10-14, 2003. The symposium highlights current work in neural regeneration, especially in areas of research where there has been recent progress or some particularly interesting issues have been raised. Full-text manuscripts for both issues of JRRD are available, free of charge, on-line at http://www.vard.org.
Neuromuscular electrical stimulation improves tissue health, pg # 469
Study investigated whether chronic use of neuromuscular electrical stimulation (NMES) by individuals with spinal cord injury (SCI) improves seating support. Changes in tissue health were monitored in eight individuals with SCI using an implanted NMES system to stand and to facilitate standing transfers. Veterans with SCI are at a high risk of developing pressure ulcers because of paralysis and immobilization. Study results indicate that chronic use of NMES significantly improves tissue health, as well as enhances the health, wellbeing, and independence of veterans with disabilities.
Orthoses selection improves clinical outcome following cervical injury, pg# 527
Study compared four cervical orthoses in limiting spine motion. Twenty volunteers were tested in bending and reaching with and without orthosis. All four orthoses significantly reduced cervical motion. Study findings will help clinicians select the optimum cervical orthosis for nonsurgical and postsurgery use based on biomechanical performance of cervical orthoses. Selecting the optimum cervical orthosis increases the veterans' clinical outcome in nonsurgical treatment of cervical disorders, minimizes postsurgery complications, and reduces the incidence of failed reconstructive procedures for cervical injuries and degenerative disorders.
Home exercise program improves upper-body endurance for wheelchair users, pg# 501
Research determined if a home exercise program would improve cardiorespiratory endurance in manual wheelchair users, with and without upper-limb impairment. Twenty-seven manual wheelchair users completed a 12-week monitored home exercise program, which included biweekly visits to the laboratory to monitor progress and adherence. Aerobic capacity and exercise endurance tests were completed before training, at six weeks, and after exercise program completion. Results suggest that a home exercise program simulating propulsion can improve endurance in users of wheelchairs. Those with upper-limb impairment received the greatest benefits. Improved endurance may reduce the incidence of overuse injuries that could further impede ambulation in this population.
Electrical stimulation increases elbow extension in individuals with SCI, pg # 477
Study evaluated the effect of electrical stimulation on the paralyzed triceps of individuals with tetraplegia, measuring the increase in elbow extension strength and controllable workspace. Measurements were taken on 11 individuals with cervical level spinal cord injuries (SCIs). Elbow extension was measured at different elbow angles, along with the number of times and speed in moving an object to different positions in a workspace. Elbow extension neuroprostheses provided statistically significant increases in the ability of an individual to successfully reach and move an object, and significantly decreased the time required to grasp an object while reaching. Addition of a triceps electrode to the neuroprosthetic hand grasps of patients with SCIs can significantly increase their ability to extend their arms and increase their controllable workspace.
Elbow trajectory tracking a measure of rehabilitation effectiveness poststroke, pg# 487
Study established the reliability and responsiveness of a novel task for assessing upper-limb motor control in adults with muscle weakness. Eleven persons with chronic poststroke hemiparesis (muscle weakness) and eleven controls performed an elbow tracking task involving bending and reaching against a low-resistance isotonic load. Both arms (paretic and nonparetic or dominant and nondominant) were tested during two identical sessions separated by one week. Both control and hemiparetic subjects demonstrated reproducible performances. Because of greater trial-to-trial variability observed in both nonparetic and paretic arms, smallest real difference scores were greater in hemiparetic subjects, indicating larger improvements must be demonstrated to conclude the efficacy of rehabilitative therapy.
Veterans with SCI depend on graying family for daily healthcare needs, pg # 511
Study determined the number of veterans with spinal cord injury (SCI) who rely on informal assistance to provide for daily physical needs. Study also described primary family care providers' characteristics, assessed perceptions of informal care networks stability, and explored self-reported care and perceived network instability. More than a third of respondents reported receiving informal unpaid assistance with personal care activities. Primary informal caregivers provided more than 11 hours of care a day, on average. Nearly a third of veterans described their primary caregiver as being in fair or poor health, and one-fourth reported that their primary caregiver was unlikely to provide the same care five years from now. More than half stated that they did not have an alternate caregiver.
Weight-bearing conditions alter foot shape, pg# 517
Study quantifies the effects of weight bearing on the plantar foot shape. The plantar foot shapes of 16 normal feet were obtained by an impression casting method under three weight-bearing conditions: non-weight bearing, semi-weight bearing, and full-weight bearing. Measurements and comparisons were made on the digitized foot shapes for the whole foot and selected regions. Data showed that increased weight bearing significantly increased the contact area, foot length, and foot width, while at the same time decreasing average height, arch height, and arch angle. Knowledge of the range of plantar foot shape alteration under weight bearing can aid the design and construction of comfortable and functional foot support.
Neuroprosthesis proven safe and reliable for restoring function in patients with SCI, pg# 457
Study evaluated the durability and reliability of implanted leads and electrodes that are part of an implanted upper-limb neuroprosthesis. The neuroprosthesis provides grasping and reaching functions to individuals with spinal cord injury (SCI). Twenty-seven subjects who had sustained a traumatic SCI and been implanted with an upper-limb neuroprosthesis were studied. Results indicate that the electrode, lead, and connector systems are extremely durable. Each electrode had been implanted at least three years, with a maximum implantation time of over 16 years. Only three electrode-lead failures and only one electrode infection occurred, for a survival rate of almost 99%. Electrode threshold measurements indicate that the electrode response is stable over time, with no evidence of electrode migration or continual encapsulation in any of the electrodes studied.
JRRD is a peer-reviewed, scientifically indexed publication covering all rehabilitation research disciplines: neurology, orthopedics, engineering, audiology, ophthalmology, outcomes, prosthetics, geriatrics, psychiatrics, and community reintegration. Formerly the Bulletin of Prosthetics Research, JRRD debuted in 1983 to include cross-disciplinary findings in rehabilitation. JRRD accepts original research papers, review articles, as well as clinical and technical commentary from U.S. and international researchers who investigate disability rehabilitation.
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