Abstract-In this study, adults with Parkinson's disease (PD) used virtual cueing spectacles (VCS) mimicking kinesia paradoxa in home and community settings to assess the impact on mobility and participation. We used an ABA single-subject design with repeated measures. Six adults with PD, akinesia, and stage III or IV Hoehn and Yahr rating scale status used VCS in their homes and communities for a week or more. Our main outcome measures included participant counts of losses of balance and freezes, pre-/postintervention completion of the Parkinson's Disease Questionnaire-39, observation of baseline and intervention gait, and an interview regarding user satisfaction with VCS. We also assessed participants' preuse baseline and return to baseline. Use of VCS decreased length of freezes as well as number of freezes for some participants. All participants expressed satisfaction with VCS. VCS shows promise in simulating kinesia paradoxa to improve the gait of some adults with PD in the home and community.
Physical and social environmental influences on functioning are complex. Adaptation to vision loss is an ongoing process that may be aided by peer interactions and more community-based rehabilitation. To best rehabilitate people with low vision due to diabetic retinopathy, the influence of both the physical and social environment along with psychological adaptation need to be considered. Periodic rehabilitation, interventions taking place in community settings and the formal inclusion of peers in the rehabilitation process may be indicated. Implications for Rehabilitation Consideration of the social as well as the physical environment is essential in the rehabilitation of people with low vision due to diabetic retinopathy. Adaptation to vision loss by those with diabetic retinopathy is complicated by the fact that diabetes is a systemic disease that affects multiple body systems. Psychological adaptation to vision loss is characterized by cycles of grieving and acceptance, which affects readiness for rehabilitation. Alternative approaches to rehabilitation may be indicated for people with low vision due to diabetic retinopathy, including periodic intervention over time and the inclusion of peers in the rehabilitation process.
Date Presented 04/06/19 A literature review was completed to examine the efficacy of everyday technology as a treatment modality to improve upper-extremity motor control and motivation for people recovering from stroke. The evidence was promising in support of the use of everyday technology with this population, as indicated by client and clinician reports of satisfaction, motivation, and engagement in poststroke rehabilitation, as well as increased upper-extremity motor control. Primary Author and Speaker: Tatiana Kaminsky Contributing Authors: Dillon Oldham, Claire Ferree, Amanda Robert, Alana Yee, George Tomlin
Date Presented 3/30/2017 A literature review found the incidence of cognitive impairment in those with high-level SCI to be 70%–77% from brain injury and other comorbidities. These impairments are often overlooked. Cognitive screening is essential for appropriate care, but there is a shortage of appropriate assessments. Primary Author and Speaker: Susan Doyle Additional Authors and Speakers: Tatiana Kaminsky Contributing Authors: Michael DeWilde, Jon-Erik Golob, Olivia Allen
In collaboration with Heidi Shaffer, one of the occupational therapists on staff at the MultiCare lymphedema clinic in Gig Harbor, Washington, we sought to answer the question "Which patient-reported outcome assessments are most valid and reliable in measuring health-related quality of life (HRQoL) in patients with lymphedema?" We conducted a systematic literature review to answer this question. In reviewing selected databases, 19 articles were chosen to appraise the evidence supporting psychometric properties and clinical utility of 10 HRQoL assessments used for patients with lymphedema. The Disability of the Arm, Shoulder and Hand (DASH) and Lymphedema Life Impact Scale (LLIS) assessments demonstrated stronger evidence for test-retest reliability, internal consistency, and clinical utility for use in a lymphedema practice setting in the U.S. than other assessments. The next step was to bring the findings back to Heidi and her colleagues to answer questions they had about using recommended assessments to generate G-codes for Medicare reporting and to explore strategies that could be used to implement these recommended assessments within MultiCare's electronic medical record (EMR) system. We provided an in-service on our findings for MultiCare's lymphedema therapists, at which time we distributed laminated calculation cards for converting DASH scores to G-code modifiers and obtained feedback through a satisfaction survey. In addition, we met with the Director of Physical Medicine and Rehabilitation at MultiCare, Sherri Olsen, to determine the best process for embedding the LLIS and the DASH into their EMR and identify future research needs. Additional steps will include follow up on the progress and outcomes of embedding the assessments into the EMR and further research to address changes in the literature, HRQoL assessments for other diagnostic populations, and determining the efficacy and benefits of prehab treatments. LYMPHEDEMA HRQOL ASSESSMENTS Executive SummaryThis year-long review effort began by asking the question, "Which functional outcome measures used by lymphedema therapists are best for determining G-codes?" In order to meet the needs of our collaborating clinician, Heidi Shaffer from the MultiCare lymphedema clinic in Gig Harbor, our research question was changed to, "Which patient-reported outcome assessments are most valid and reliable in measuring health-related quality of life in patients with lymphedema?" Currently, HRQoL measures specific to patients with lymphedema are lacking psychometric rigor. These instruments are particularly critical following a recent mandate by Medicare to produce G-codes, which report function-related outcomes. Our aim with this literature review was to provide local lymphedema therapists with recommended HRQoL assessments that could be used within the facility's electronic medical record (EMR) system to generate Medicare G-codes.We conducted a systematic literature review to appraise the evidence supporting the psychometric properties and clinical utility of 10 HRQ...
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