Lower than expected-for-age BMD was very frequent in adults with CP with mobility limitations, present at both spine and hip sites. Low BMI and need for transfer assistance had a negative impact on BMD. Although not statistically significant, progression of abnormalities was seen at follow-up for DXAs Z-scores at some sites, which suggests longitudinal studies in this population are needed.
Objective Clostridium difficile infection is a common hospital-associated infection spread via patient contact or contaminated environments. The risk for spread of C difficile may be greater in inpatient rehabilitation units than in some hospital units as patients are not confined to their rooms and often share equipment. Environmental disinfection is challenging in shared medical equipment, especially in equipment with complex designs. The study aimed to examine the presence of C difficile spores within an acute rehabilitation environment and to evaluate disinfection effectiveness. Design Cultures were performed on 28 rehabilitation rooms, 28 rehabilitation floor surfaces, and 80 shared devices and equipment. Two disinfection interventions were implemented, and environmental cultures then were repeated postintervention. Results Environmental cultures positive for CD spores were rehabilitation rooms (1/28), rehabilitation floors (13/28), and wheelchairs (3/20). After the implementation of new disinfection methods, repeat cultures were obtained and produced negative results. Conclusions Nonsporicidal disinfectant was not effective on hospital floors. Sporicidal disinfection of the floor is important when rates of C difficile infection are increased. Wheelchairs are complex devices and difficult to properly clean. The hospital purchased an ultraviolent device for wheelchair cleaning with a subsequent reduction in spores on repeat cultures. To Claim CME Credits Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives Upon completion of this article, the reader should be able to: (1) Recognize the impact of Clostridium difficile infections on the healthcare system; (2) Describe potential reservoirs of Clostridium difficile in the inpatient rehabilitation environment; and (3) Discuss interventions that may be implemented to reduce the reservoirs of Clostridium difficile on the rehabilitation unit. Level Advanced Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Objective: To describe the impact of an education program to prevent falls in full-time manual wheelchair users (MWU) living with Spinal Cord Injury (SCI). Design: Pre/post. At baseline, participants reported the frequency of falls over the past six months and completed the Community Participation Indicators(CPI) and the World Health Organization Quality of Life (short version -WHO-QOL BREF) assessment. Transfer quality to and from a mat table was assessed using the Transfer Assessment Instrument (TAI) and boundaries of seated stability were evaluated using standardized procedures. After baseline testing, a structured education program designed to decrease fall frequency was implemented. After the intervention, participants were asked to prospectively track fall frequency for 12 weeks. After 12 weeks, the assessment, as described above, was repeated. Participant/methods: 18 fulltime MWUs with SCI participated in the study. Participants were an average of 35.78 ± 13.89 y.o. and lived with their SCI for an average of 17 ± 15 years. The majority of participants were female (n = 11, 61.1%). Level of injury ranged from C4-L3, AIS A-C. To examine the differences in outcomes pre and post exposure to the education program, seated stability was evaluated using a paired t-test. Nonparametric Wilcoxon tests were used to evaluate all other variables due to the ordinal or non-normally distributed nature of the data. Results: After exposure to the intervention, fall frequency significantly decreased, (Pre: 1.37 ± 1.62 falls per month, Post: 0.67 ± 0.82, p = 0.047). A trend in the data indicated improvements in seated stability (Pre:
Objective: To identify factors associated with low bone mineral density (BMD) in adults with cerebral palsy (CP) and assess for longitudinal changes. Design: Retrospective Chart Review. Setting: Urban academic rehabilitation clinic. Participants: Adults with CP seen over a 3-year period who underwent dual-energy x-ray absorptiometry (DEXA) scan(s) to assess bone health status. Interventions: Not applicable Main Outcome Measures: BMD T-and Z-scores for the lumbar (L) spine (total) and hip (right [R] and left [L], femoral neck and total), Percent change in T/Z-scores from baseline to follow-up, DEXA, Gross Motor Functional Classification Scale (GMFCS), CP pattern (hemiplegic, diplegia,or quadriplegic), Ambulation status (none, exercise only, household, community), and body mass index (BMI). Results or Clinical Course: Thirty-five adults (20 male) were identified who underwent DEXAs; 15 had two DEXAs performed. GMFCS levels were II-III in 4, IV in 18 and V in 12. 28 had quadriplegic, 2 hemiplegic and 5 diplegic patterns. Mean age at time of DEXA was 39.2 (SD 13.9) years with 83% younger than age 50. Mean BMI was 23.7 kg/m 2 (SD 6.14).
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