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Watson JD, Perrin PB, Xia B, Arango-Lasprilla JC. Disparities between Native Americans and Whites in trajectories of functional independence and life satisfaction over the 5 years after traumatic brain injury. Rehabil Psychol 2024:2024-64655-001. [PMID: 38512180 DOI: 10.1037/rep0000553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
PURPOSE Traumatic brain injury (TBI) can lead to impairments in motor and cognitive function and reduced life satisfaction. TBI is one of the leading causes of death and disability worldwide and disproportionately affects Native Americans, who have the highest rates of TBI among all races in the United States and elevated likelihood for fatality and severe complications. This study investigated whether disparities in functional and life satisfaction outcomes exist longitudinally over the 5 years after complicated mild, moderate, or severe TBI between Native Americans and White individuals; it further explored which demographic and injury-related covariates account for them. RESEARCH METHOD The current study used a subsample of the national TBI Model Systems Database of 80 demographically and injury-severity matched Native American and White pairs (total n = 160). RESULTS A series of longitudinal hierarchical linear models found that Native Americans experienced significantly lower Functional Independence Measure Cognitive and Motor trajectories than Whites; however, life satisfaction was comparable. Native Americans had declining cognitive function over time relative to a slight increase in White individuals. This differential movement dissipated with the addition of employment status at the time of injury and type of health insurance. CONCLUSIONS These results demonstrate a profound need to further investigate the cultural and contextual variables unique to Native Americans that underlie these differences and highlight the importance of culturally responsive treatment and rehabilitation in bridging the gap in recovery. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Jack D Watson
- Department of Psychology, Virginia Commonwealth University
| | | | - Bridget Xia
- School of Data Science, University of Virginia
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Tinti L, Lawson T, Molteni E, Kondziella D, Rass V, Sharshar T, Bodien YG, Giacino JT, Mayer SA, Amiri M, Muehlschlegel S, Venkatasubba Rao CP, Vespa PM, Menon DK, Citerio G, Helbok R, McNett M. Research considerations for prospective studies of patients with coma and disorders of consciousness. Brain Commun 2024; 6:fcae022. [PMID: 38344653 PMCID: PMC10853976 DOI: 10.1093/braincomms/fcae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 01/04/2024] [Accepted: 01/26/2024] [Indexed: 03/02/2024] Open
Abstract
Disorders of consciousness are neurological conditions characterized by impaired arousal and awareness of self and environment. Behavioural responses are absent or are present but fluctuate. Disorders of consciousness are commonly encountered as a consequence of both acute and chronic brain injuries, yet reliable epidemiological estimates would require inclusive, operational definitions of the concept, as well as wider knowledge dissemination among involved professionals. Whereas several manifestations have been described, including coma, vegetative state/unresponsive wakefulness syndrome and minimally conscious state, a comprehensive neurobiological definition for disorders of consciousness is still lacking. The scientific literature is primarily observational, and studies-specific aetiologies lead to disorders of consciousness. Despite advances in these disease-related forms, there remains uncertainty about whether disorders of consciousness are a disease-agnostic unitary entity with a common mechanism, prognosis or treatment response paradigm. Our knowledge of disorders of consciousness has also been hampered by heterogeneity of study designs, variables, and outcomes, leading to results that are not comparable for evidence synthesis. The different backgrounds of professionals caring for patients with disorders of consciousness and the different goals at different stages of care could partly explain this variability. The Prospective Studies working group of the Neurocritical Care Society Curing Coma Campaign was established to create a platform for observational studies and future clinical trials on disorders of consciousness and coma across the continuum of care. In this narrative review, the author panel presents limitations of prior observational clinical research and outlines practical considerations for future investigations. A narrative review format was selected to ensure that the full breadth of study design considerations could be addressed and to facilitate a future consensus-based statement (e.g. via a modified Delphi) and series of recommendations. The panel convened weekly online meetings from October 2021 to December 2022. Research considerations addressed the nosographic status of disorders of consciousness, case ascertainment and verification, selection of dependent variables, choice of covariates and measurement and analysis of outcomes and covariates, aiming to promote more homogeneous designs and practices in future observational studies. The goal of this review is to inform a broad community of professionals with different backgrounds and clinical interests to address the methodological challenges imposed by the transition of care from acute to chronic stages and to streamline data gathering for patients with disorders of consciousness. A coordinated effort will be a key to allow reliable observational data synthesis and epidemiological estimates and ultimately inform condition-modifying clinical trials.
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Affiliation(s)
- Lorenzo Tinti
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan 20156, Italy
| | - Thomas Lawson
- Critical Care, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Erika Molteni
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EU, UK
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen 2100, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen 2200, Denmark
| | - Verena Rass
- Department of Neurology, Neuro-Intensive Care Unit, Medical University of Innsbruck, Innsbruck 6020, Austria
| | - Tarek Sharshar
- Neuro-Intensive Care Medicine, Anaesthesiology and ICU Department, GHU-Psychiatry and Neurosciences, Pole Neuro, Sainte-Anne Hospital, Institute of Psychiatry and Neurosciences of Paris, INSERM U1266, Université Paris Cité, Paris 75006, France
| | - Yelena G Bodien
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA 02129, USA
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA 02129, USA
| | - Stephan A Mayer
- Department of Neurology, New York Medical College, Valhalla, NY 10595, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY 10595, USA
| | - Moshgan Amiri
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen 2100, Denmark
| | - Susanne Muehlschlegel
- Department of Neurology and Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Chethan P Venkatasubba Rao
- Division of Vascular Neurology and Neurocritical Care, Baylor College of Medicine and CHI Baylor St Luke’s Medical Center, Houston, TX 77030, USA
| | - Paul M Vespa
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Cambridge CB2 1TN, UK
| | - Giuseppe Citerio
- NeuroIntensive Care, IRCSS Fondazione San Gerardo dei Tintori, Monza 20900, Italy
- School of Medicine and Surgery, Università Milano Bicocca, Milan 20854, Italy
| | - Raimund Helbok
- Department of Neurology, Neuro-Intensive Care Unit, Medical University of Innsbruck, Innsbruck 6020, Austria
- Department of Neurology, Johannes Kepler University, Linz 4040, Austria
| | - Molly McNett
- College of Nursing, The Ohio State University, Columbus, OH 43210, USA
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Won P, Stoycos SA, Ding L, McMullen KA, Kowalske K, Stewart BT, Yenikomshian HA. Worse Itch and Fatigue in Racial and Ethnic Minorities: A Burn Model System Study. J Burn Care Res 2023; 44:1445-1451. [PMID: 37083246 PMCID: PMC10589385 DOI: 10.1093/jbcr/irad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Indexed: 04/22/2023]
Abstract
Racial and ethnic minority patients experience worse hypertrophic scars after burn injury than White patients. Subsequently, minority patients encounter differences in scar-related recovery domains such as itch and fatigue. This study examines disparities regarding postburn injury itch and fatigue in minority patients to better inform counseling and treatment considerations. From the multicenter National Institute of Disability, Independent Living and Rehabilitation Research Burn Model System Database (2015-2019), outcomes were analyzed at three time-points (discharge from index hospitalization, 6- and 12-months post-injury) using the 5D Itch and PROMIS-29 Fatigue measures. Multilevel linear mixed effects regression modeling analyzed associations between race/ethnicities and outcomes over time. Of 893 total patients, minority patients reported higher/worse itch scores at all time points compared to White patients. Itch scores were significantly higher for Black patients at 6 months (β = 1.42, P = .03) and 12 months (β = 3.36, P < .001) when compared to White patients. Black patients reported higher fatigue scores than White patients at all time points. Fatigue scores were significantly higher for Hispanic/Latino patients at discharge (β = 6.17, P < .001), 6 months (β = 4.49, P < .001), and 12 months (β = 6.27, P < .001) than White patients. This study supports investigation of potential factors leading to increased itch and fatigue such as sociocultural factors, disparities in healthcare access, and psychosocial impacts of these symptoms. In the short-term, minority patients may benefit from additional counseling and focused treatments addressing itch and fatigue after burn injury.
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Affiliation(s)
- Paul Won
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Sarah A Stoycos
- Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Li Ding
- Southern California Clinical and Translational Science Institute, Los Angeles, California, USA
| | | | - Karen Kowalske
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, Texas, USA
| | - Barclay T Stewart
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Haig A Yenikomshian
- Division of Plastic Surgery, University of Southern California, Los Angeles, California, USA
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Kuzu D, Valentine TR, Kratz AL. Temporal associations between use of psychoactive substances and somatic symptoms in the daily lives of people with fibromyalgia. Pain Med 2023; 24:1176-1182. [PMID: 37243707 PMCID: PMC10546481 DOI: 10.1093/pm/pnad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Consumption of psychoactive substances-alcohol, nicotine, caffeine, opioids, and cannabis-is common among people with fibromyalgia. Associations between the use of substances and somatic symptoms could reflect efforts to cope with symptoms, aggravation or alleviation of symptoms after the use of substances, or a combination of these. To date, no study has provided insight into temporal associations between the consumption of psychoactive substances and fluctuations in somatic symptoms. We explored whether changes in ratings of pain and fatigue (mental and physical) predicted the later use of psychoactive substances or vice versa (substance use predicting later change in symptoms). DESIGN Micro-longitudinal design. SETTING/SUBJECTS Fifty adults (88% female, 86% White, mean age of 44.9 years) with fibromyalgia. METHODS Participants completed ecological momentary assessments of substance use, pain intensity, and physical/mental fatigue 5 times per day for 8 days. RESULTS Results of multilevel models indicated that momentary increases in fatigue showed a consistent association with greater odds of later use of psychoactive substances, whereas momentary increases in pain were related to lower odds of later cannabis and nicotine use and higher odds of later alcohol use. Only nicotine use predicted later mental fatigue. CONCLUSION Findings highlight the importance of individualized interventions for symptom management or problems related to the use of psychoactive substances. We observed that although somatic symptoms predicted later use of substances, use of substances did not show appreciable effects with regard to alleviating somatic symptoms in people with fibromyalgia.
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Affiliation(s)
- Duygu Kuzu
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI 48109,United States
| | - Thomas R Valentine
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI 48109,United States
| | - Anna L Kratz
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI 48109,United States
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Simon AM, Finucane SB, Ikeda AJ, Cotton RJ, Hargrove LJ. Powered knee and ankle prosthesis use with a K2 level ambulator: a case report. Front Rehabil Sci 2023; 4:1203545. [PMID: 37387731 PMCID: PMC10300561 DOI: 10.3389/fresc.2023.1203545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/25/2023] [Indexed: 07/01/2023]
Abstract
Powered prosthetic knees and ankles have the capability of restoring power to the missing joints and potential to provide increased functional mobility to users. Nearly all development with these advanced prostheses is with individuals who are high functioning community level ambulators even though limited community ambulators may also receive great benefit from these devices. We trained a 70 year old male participant with a unilateral transfemoral amputation to use a powered knee and powered ankle prosthesis. He participated in eight hours of therapist led in-lab training (two hours per week for four weeks). Sessions included static and dynamic balance activities for improved stability and comfort with the powered prosthesis and ambulation training on level ground, inclines, and stairs. Assessments were taken with both the powered prosthesis and his prescribed, passive prosthesis post-training. Outcome measures showed similarities in velocity between devices for level-ground walking and ascending a ramp. During ramp descent, the participant had a slightly faster velocity and more symmetrical stance and step times with the powered prosthesis compared to his prescribed prosthesis. For stairs, he was able to climb with reciprocal stepping for both ascent and descent, a stepping strategy he is unable to do with his prescribed prosthesis. More research with limited community ambulators is necessary to understand if further functional improvements are possible with either additional training, longer accommodation periods, and/or changes in powered prosthesis control strategies.
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Affiliation(s)
- Ann M. Simon
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, United States
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
| | - Suzanne B. Finucane
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Andrea J. Ikeda
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - R. James Cotton
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, United States
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
| | - Levi J. Hargrove
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, United States
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States
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Maggard BL, Gies LM, Sidol CA, Moscato EL, Schmidt M, Landry SH, Makoroff KL, Rhine TD, Wade SL. Online Intervention for Caregivers of Children with Early Traumatic Brain Injury: Pilot Trial. J Pediatr Psychol 2023; 48:205-215. [PMID: 36240452 PMCID: PMC9619775 DOI: 10.1093/jpepsy/jsac080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To assess the feasibility and acceptability of an online parenting-skills program for caregivers of young children with traumatic brain injury (TBI). Positive parenting contributes to recovery following early TBI and social and emotional development in typically developing children. Yet, few interventions have been designed to support psychosocial recovery and subsequent development after early TBI. METHODS This study protocol was registered with clinicaltrials.gov (NCT05160194). We utilized an academic hospital's Trauma Registry to recruit caregivers of children, ages 0-4 years, previously hospitalized for TBI. The GROW intervention integrated six online learning modules with videoconference meetings with a coach to review and practice skills while receiving in vivo coaching and feedback. Interactive modules addressed strategies for responsive parenting, stimulating cognition, and managing parenting stress. Enrollment and retention rates served as feasibility metrics and satisfaction surveys assessed acceptability. RESULTS 18 of 72 families contacted (25%) consented, and 11 of 18 (61%) completed the intervention and follow-up assessments. All participants rated the intervention as helpful and indicated that they would recommend the intervention to others. All endorsed a better understanding of brain injury and how to optimize their child's recovery and development. Both coaches rated intervention delivery as comparable to traditional face-to-face treatment. CONCLUSIONS Low levels of uptake and initial engagement underscore the challenges of intervening with caregivers following early TBI, which likely were exacerbated due to the COVID-19 pandemic. High levels of acceptability and perceived benefit support the potential utility of GROW while highlighting the need to improve accessibility and early engagement.
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Affiliation(s)
- Brianna L Maggard
- All correspondence concerning this article should be addressed to Brianna L. Maggard, BA, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA. E-mail:
| | - Lisa M Gies
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Psychology, University of Cincinnati College of Arts and Science, Cincinnati, OH, USA
| | - Craig A Sidol
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Psychology, University of Cincinnati College of Arts and Science, Cincinnati, OH, USA
| | - Emily L Moscato
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Psychology, University of Cincinnati College of Arts and Science, Cincinnati, OH, USA
| | - Matthew Schmidt
- College of Education, University of Florida, Gainesville, FL, USA
| | - Susan H Landry
- Children’s Learning Institute, University of Texas Health, Houston, TX, USA
| | - Kathi L Makoroff
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Mayerson Center for Safe and Healthy Children, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Tara D Rhine
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Shari L Wade
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Psychology, University of Cincinnati College of Arts and Science, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Abstract
OBJECTIVE This study examined lexical and neuroanatomic correlates of reading errors in individuals with spatial neglect, defined as a failure to respond to stimuli in the side of space opposite a brain lesion, causing functional disability. METHOD One-hundred and ten participants with left spatial neglect after right-hemisphere stroke read aloud a list of 36 words. Reading errors were scored as "contralesional" (error in the left half of the word) or as "other." The influence of lexical processing on neglect dyslexia was studied with a stepwise regression using word frequency, orthographic neighborhood (number of same length neighbors that differ by 1 letter), bigram and trigram counts (number of words with the same 2- and 3-letter combinations), length, concreteness, and imageability as predictors. MRI/CT images of 92 patients were studied in a voxelwise lesion-symptom analysis (VLSM). RESULTS Longer length and more trigram neighbors increased, while higher concreteness reduced, the rate of contralesional errors. VLSM revealed lesions in the inferior temporal sulcus, middle temporal and angular gyri, precuneus, temporal pole, and temporo-parietal white matter associated with the rate of contralesional errors. CONCLUSIONS Orthographic competitors may decrease word salience, while semantic concreteness may help constrain the selection of available word options when it is based on degraded information from the left side of the word. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Olga Boukrina
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ
| | - Peii Chen
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ
| | - Tamara Budinoska
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ
| | - A.M. Barrett
- Center for Visual & Neurocognitive Rehabilitation, Atlanta VA Medical Center, Decatur, GA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA
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Mhatre A, Reese N, Pearlman J. Design and evaluation of a laboratory-based wheelchair castor testing protocol using community data. PLoS One 2020; 15:e0226621. [PMID: 31923276 PMCID: PMC6953824 DOI: 10.1371/journal.pone.0226621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 11/29/2019] [Indexed: 11/19/2022] Open
Abstract
Wheelchair castors fail frequently causing physical, social and economic consequences for wheelchair users. These failures occur in spite of established wheelchair test methods and regulations, suggesting that the existing tests may not be sufficient to screen poorly designed castors. An expert stakeholder group, convened by the International Society of Wheelchair Professionals (ISWP), noted castor failures as a high priority and recommended that a new castor testing system should be developed. In a previous study, the effect of shock exposure on castor durability was studied. The current paper extends the previous work and focuses on the development of a castor testing protocol based on shock, corrosion and abrasion exposure data collected in the community. The testing protocol was applied to 8 different castor models tested under four conditions: shock, corrosion + shock, abrasion + shock and abrasion + corrosion + shock. For each model, a total of n = 8 samples were evaluated across the four conditions. Results demonstrate that corrosion and abrasion reduced castor durability between 13% to 100% depending on the model. Importantly, the inclusion of corrosion and abrasion resulted in changes in the failure modes for 75% of the tested models and two-thirds of the altered failure modes are associated with increased risk of injury for wheelchair users. These results suggest that corrosion and abrasion present in the community reduce castor durability, thus supporting their inclusion in the castor testing protocol and potentially other wheelchair standards.
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Affiliation(s)
- Anand Mhatre
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- International Society of Wheelchair Professionals, Pittsburgh, Pennsylvania, United States of America
| | - Norman Reese
- International Society of Wheelchair Professionals, Pittsburgh, Pennsylvania, United States of America
- Engineering & Engineering Technology, LeTourneau University, Longview, Texas, United States of America
| | - Jon Pearlman
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- International Society of Wheelchair Professionals, Pittsburgh, Pennsylvania, United States of America
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Pierella C, Casadio M, Mussa-Ivaldi FA, Solla SA. The dynamics of motor learning through the formation of internal models. PLoS Comput Biol 2019; 15:e1007118. [PMID: 31860655 PMCID: PMC6944380 DOI: 10.1371/journal.pcbi.1007118] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 01/06/2020] [Accepted: 11/23/2019] [Indexed: 11/19/2022] Open
Abstract
A medical student learning to perform a laparoscopic procedure or a recently paralyzed user of a powered wheelchair must learn to operate machinery via interfaces that translate their actions into commands for an external device. Since the user's actions are selected from a number of alternatives that would result in the same effect in the control space of the external device, learning to use such interfaces involves dealing with redundancy. Subjects need to learn an externally chosen many-to-one map that transforms their actions into device commands. Mathematically, we describe this type of learning as a deterministic dynamical process, whose state is the evolving forward and inverse internal models of the interface. The forward model predicts the outcomes of actions, while the inverse model generates actions designed to attain desired outcomes. Both the mathematical analysis of the proposed model of learning dynamics and the learning performance observed in a group of subjects demonstrate a first-order exponential convergence of the learning process toward a particular state that depends only on the initial state of the inverse and forward models and on the sequence of targets supplied to the users. Noise is not only present but necessary for the convergence of learning through the minimization of the difference between actual and predicted outcomes.
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Affiliation(s)
- Camilla Pierella
- Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
- Department of Physiology, Northwestern University, Chicago, Illinois, United States of America
- Shirley Ryan Ability Lab, Chicago, Illinois, United States of America
| | - Maura Casadio
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
- Department of Physiology, Northwestern University, Chicago, Illinois, United States of America
| | - Ferdinando A. Mussa-Ivaldi
- Department of Physiology, Northwestern University, Chicago, Illinois, United States of America
- Shirley Ryan Ability Lab, Chicago, Illinois, United States of America
- Department of Physical Medicine and Rehabilitation, Northwestern University, Evanston, Illinois, United States of America
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, United States of America
| | - Sara A. Solla
- Department of Physiology, Northwestern University, Chicago, Illinois, United States of America
- Department of Physics and Astronomy, Northwestern University, Evanston, Illinois, United States of America
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Panaite V, Brown R, Henry M, Garcia A, Powell-Cope G, Vanderploeg RD, Belanger HG. Post-deployment Mental Health Screening: A Systematic Review of Current Evidence and Future Directions. Adm Policy Ment Health 2018; 45:850-875. [PMID: 29603055 DOI: 10.1007/s10488-018-0869-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Population-based post-deployment screening programs within the Departments of Defense and Veterans Affairs have been implemented to assess for mental health conditions and traumatic brain injury. The purpose of this paper is to systematically review the literature on post-deployment screening within this context and evaluate evidence compared to commonly accepted screening implementation criteria. Findings reflected highly variable psychometric properties of the various screens, variable treatment referral rates following screening, low to moderate treatment initiation rates following screening, and no information on treatment completion or long-term outcomes following screening. In sum, the evidence supporting population based post-deployment screening is inconclusive. Implications are discussed.
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Affiliation(s)
- Vanessa Panaite
- HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, 8900 Grand Oak Circle, 104B, Tampa, FL, 33637, USA.
- Departments of Psychology, University of South Florida, Tampa, FL, USA.
| | - Racine Brown
- HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, 8900 Grand Oak Circle, 104B, Tampa, FL, 33637, USA
| | | | - Amanda Garcia
- Department of Mental Health and Behavioral Sciences, James A. Haley VA, Tampa, FL, USA
| | - Gail Powell-Cope
- HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, 8900 Grand Oak Circle, 104B, Tampa, FL, 33637, USA
| | - Rodney D Vanderploeg
- Department of Mental Health and Behavioral Sciences, James A. Haley VA, Tampa, FL, USA
- Departments of Psychology, University of South Florida, Tampa, FL, USA
- Psychiatry & Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
- Defense and Veterans Brain Injury Center, Tampa, FL, USA
| | - Heather G Belanger
- HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, 8900 Grand Oak Circle, 104B, Tampa, FL, 33637, USA
- Department of Mental Health and Behavioral Sciences, James A. Haley VA, Tampa, FL, USA
- Psychiatry & Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
- Defense and Veterans Brain Injury Center, Tampa, FL, USA
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