Veterans in better health than other residents of nursing homes, new test for evaluating tinnitus

December 29, 2004

Molecular study of osseointegration, comparison of veterans to other residents of community nursing homes, new test for evaluating tinnitus pitch and loudness

The current issue of the Journal of Rehabilitation Research and Development (JRRD) includes a dozen articles that focus on the multidisciplinary field of rehabilitation medicine, including a comparison of male veterans to other male residents of community nursing homes, a description of a new test for evaluating tinnitus pitch and loudness, a molecular study of osseointegration, the effect of walking speed on gait, and a study that is the first to use physical and emotional health status to measure a person's disability. Full-text articles are available, free, online at www.vard.org.

MANUSCRIPTS FEATURED IN VOLUME 41, NUMBER 6

Physical and emotional health status used for the first time to measure disability
This study profiles a person's ability to perform basic daily-living activities based on both physical disability and emotional well-being. Investigators assessed patients receiving rehabilitation therapy in Rome, Italy, for spinal cord injury, Parkinson's disease, depression, or stroke. Patients were grouped into four different profiles of functional ability based on degree of physical and emotional disability: from a rating of low (independent patients) to high (patients with severe disability). These disability profiles represent a significant step in defining patients with similar levels of disability who can be treated by standardized rehabilitative programs.

Prosthesis with suction suspension system better for amputee with active lifestyle
This study compares pressure applied to the residual limb with pin and suction suspension systems to identify causes of residual limb skin problems. Eight transtibial amputees performed three walking trials with the pin and suction suspension systems. During the swing phase of walking, the pin system compressed the upper residual limb and had significantly higher suction at the end of the residual limb than the suction system. Investigators conclude that walking with the pin liner likely disrupts circulation within the residual limb, resulting in skin changes. The pin suspension system may be inappropriate for an active amputee or those with circulatory complications.

First physical activity monitor validated for older adults
This study develops a method for monitoring physical activity in older adults. Physical activity monitors commercially available have not been validated for older adults. Sixty-eight adults between the ages of 61 and 89 wore accelero-meters on their legs as they completed a 7-minute walk on a treadmill and a climbing test on a Stairmaster. Breathing and heart rate while exercising were measured. Investigators conclude that physical activity can be predicted in older adults using accelerometers on legs. Physical activity monitors geared for older adults provide a tool to measure exercise participation, known to protect against heart disease and other adverse health events.

Veterans more independent than their peers who reside in community nursing homes
This study describes health conditions, health service use, and personal characteristics of veterans in community nursing homes. Investigators used the Minimum Data Set (MDS) to compare records of 7,926 male veterans to 159,203 other male residents who were admitted to community nursing homes during 2000. MDS is a federally mandated assessment instrument that includes all nursing home residents in all Medicare- and Medicaid-certified nursing facilities in the United States. Data revealed that male veterans were significantly more independent in performing daily-living activities and less physically disabled than other male residents. Differences in disability may be due to the extensive physical medicine and rehabilitation services available to veterans enrolled in the Veterans Health Administration.

Treadmill training combined with functional neuromuscular stimulation improves walking poststroke
This study tests two promising treatments for restoring gait poststroke: body-weight-supported treadmill training (BWSTT) alone and a combination of BWSTT and functional neuromuscular stimulation (FNS) with intramuscular (IM) electrodes (FNS-IM). Sixteen volunteers were randomly assigned to one of the two treatment groups. Both groups received strengthening and coordination training, over-ground gait training, and BWSTT. The group receiving FNS-IM gait training and exercise had significant improvements in the knee and ankle movements required for walking. This is the first randomized, controlled study that reports the restoration of voluntary control of knee and ankle gait components for chronic stroke survivors.

Blood flow in skin a risk factor in ulcer development
This study investigates the physiological mechanisms controlling skin blood flow response to tissue pressure. The skin over the sacrum, the most common site for pressure ulcers, was heated in 10 volunteers. Investigators analyzed blood flow patterns and identified five characteristics associated with specific physiological responses. Study results provide a greater understanding of skin blood flow control mechanisms that may be used to prevent ulcer formation in patients at high risk, such as the elderly and individuals with spinal cord injury.

Patient controls loudness and pitch during new diagnostic test for tinnitus
This study describes a new automated testing procedure for rapidly evaluating tinnitus (ringing in the ears) loudness and pitch. Forty subjects with chronic tinnitus were each tested over two sessions with the new automated system that allows patients to control the loudness and pitch of pure tones presented during tinnitus loudness and pitch matching. Testing took an average of 19 minutes to measure hearing thresholds and loudness matches at 13 frequencies and 5 repeated pitch matches with the new system. Investigators assert that standardized assessment of tinnitus is essential, so that the perceptual attributes of the disorder can be quantified.

Less current at the start of electrical stimulation-induced cycling reduces muscle fatigue
This study evaluates the effect of experimental electrical stimulation-induced leg cycling patterns on cycling performance. Five men with spinal cord injury (SCI) performed several cycling sessions on a computer-controlled cycle ergometer using different electrical stimulation patterns. The experimental stimulation patterns did not significantly improve cycling performance compared with the standard pattern. However, investigators found that using less current during cycling sessions reduced muscle fatigue and improved cycling performance. Identifying stimulation patterns that improve cycling performance is an important step to enhancing exercise effects and optimizing health benefits for patients with SCI.

Monolimb provides same comfort and flexibility as high-end prosthetic limbs
This study investigates the effect of leg design on the flexibility and structural integrity of monolimbs and the stress distribution at the prosthetic socket-residual limb interface. The monolimb, a monolithic socket-shank endoskeletal prosthesis made of thermoplastic, is an alternative to relatively high-cost prosthetic components that offers prosthesis flexibility. A three-dimensional computer model was developed to study the structural behavior of monolimbs and interactions between the socket and the residual limb. The data revealed that stress is reduced at the socket-limb interface when a more flexible shank is used, providing a more comfortable fit.

Walking speed alters center of mass motion impacting balance and mobility in adults
This paper describes the effect of walking speed on center of mass (COM) location in adults. Fast walking results in more vertical COM movement, while slower walking results in more lateral COM movement. Investigators assert that clinicians who use observational gait analysis to assess walking problems should be aware that even normal individuals show significant lateral COM movement at slow speeds. Excessive up and down COM movement obvious at moderate walking speeds may be masked at slow walking speeds. By understanding stability challenges, physicians may improve clinical assessments and make better treatment choices to reduce falls and enhance gait speed.

Molecular study of osseointegration in rodents helps identify human candidates for new technique
This study analyzes osseointegration at the molecular level to better understand the unique relationship of a titanium implant to living bone in a rodent femur model. Osseointegration is a surgical and material science technique that allows for direct attachment of prosthetic limbs to bone. In orthopedics, the technique of osseointegration is focused on patients with difficult above-knee amputations to attach a lower-limb prosthetic device to the femur. This insight into bone biology will help define the patient selection criteria and enhance the success of the procedure.

Insole design impacts plantar pressure distribution
This study quantifies the effects of insole contours on the plantar pressure distribution. Three weight-bearing casting conditions--unloaded, semi-weight-bearing, and full-weight-bearing--were applied to custom-made insoles for both feet of eight normal and six diabetic participants. Investigators measured and compared the plantar pressure distribution of five different support conditions, including shoe-only, flat insole, and three contoured insoles for the whole foot and for selected regions. They found significantly different pressure distribution patterns among different support conditions. Knowledge of the effect of insole contours on the pressure distribution pattern can offer guidance for better design and construction of functional insole.
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About the Journal
JRRD has been a leading research journal in the field of rehabilitation medicine and technology for 40 years. JRRD, a peer-reviewed, scientifically indexed journal, publishes original research papers, review articles, as well as clinical and technical commentary from U.S. and international researchers on all rehabilitation research disciplines. JRRD's mission is to responsibly evaluate and disseminate scientific research findings impacting the rehabilitative healthcare community.

Veterans Affairs Research Communications

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