Tipsheet: Focus on gait training, pain relief, pressure ulcers and hearing aid training

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Public release date: 11-Oct-2006

http://www.eurekalert.org/pub_releases/2006-10/vrcs-tfo101106.php

Contact: Stacieanne C. Yuhasz, PhD

yuhasz@...

x240

VA Research Communications Service

Tipsheet: Focus on gait training, pain relief, pressure ulcers and

hearing aid training

Location of plantar ulcerations in diabetic patients referred to a

Department of Veterans Affairs podiatry clinic, pg. 421

We described the location of foot ulcers through a chart review of

diabetic patients in a Department of Veterans Affairs podiatry clinic

and looked for connections between ulcer location and specific medical

features. We hypothesized that individuals with diabetes rarely have

heel ulcers but that heel ulcers are directly related to peripheral

neuropathy and diminished vascular function. We found that patients with

reduced vascular function were five times more likely to have heel

ulcers than patients with adequate vascular function. The importance of

understanding the risk factors for heel ulcers stems from a lack of

available treatments. Further research should study the effectiveness of

interventions for patients with reduced vascular status.

Effects of footwear on medial compartment knee osteoarthritis, pg. 427

This pilot study investigated whether lateral-wedge insoles inserted

into shock-absorbing walking shoes relieved pain and stiffness and

improved walking in people with painful knee osteoarthritis. People with

knee pain in the medial knee compartment were asked to wear

lateral-wedge insoles in lightweight cushioned walking shoes for 4

weeks. They answered questions about the amount of pain, stiffness, and

problems with activity they had before wearing the insoles and after

wearing them for 4 weeks. The results of this study showed that the

lateral-wedge insoles decreased pain and stiffness and improved

functional status in people with knee osteoarthritis. Pain was

especially decreased for stair-climbing activities.

Isometric performance following total hip arthroplasty and

rehabilitation, pg. 435

We examined differences in strength between total hip arthroplasty (THA)

patients and community-dwelling older adults to provide comparative data

for therapists who treat THA patients. Studies based on self-report data

indicate that THA surgery successfully alleviates pain and improves

function relative to presurgical levels. However, studies based on

objective performancebased measures indicate that despite postoperative

improvements, THA patients continue to exhibit deficits in strength,

postural stability, and gait. Average hip strength during flexion

(pushing upward) was significantly less for hip patients (in both their

replaced and nonreplaced hip) compared with community-dwelling older

adults. These deficits indicate that rehabilitation is not restoring THA

patients to a level similar to their peers. Clinicians and therapists

can use these results to improve current rehabilitation protocols.

Influence of a 6-week arm exercise program on walking ability and health

status after hip arthroplasty: A 1-year follow-up pilot study, pg. 445

This follow-up study of elderly patients after total hip arthroplasty

(THA) examined the effect of our arm exercise program on health status

and walking ability. Though THA had a major effect on our patients'

physical fitness and functional status, the added effects of the

training were significant on those outcomes at both 2 months and 1 year

after surgery. In a 6-minute walk test, the training group (TG) walked

significantly longer distance than the normal rehabilitation group with

a faster speed, longer stride length, and higher step cadence.

Therefore, besides an improvement in fitness, the TG also might have

improved gait efficiency. These preliminary results suggest the

importance of endurance-type upper-body aerobic training after THA.

Are patient ratings of chronic pain services related to treatment

outcome? pg. 451

We examined the relationships between ratings of services and outcomes

of patients who received pain treatment at a teaching hospital. A group

of 122 patients who completed a multidisciplinary pain-management

program rated their satisfaction with and the effectiveness of services

as well as changes in their pain condition and quality of life. The

results indicated improvement on ratings of pain severity, pain

interference, and depression. The patients' service ratings were

significantly related to their outcomes; however, we found no

significant change in disability. The results support the importance of

assessing not only patients' satisfaction with treatment but also their

perceived changes in disability, pain, and quality of life after

pain-management services.

Using cranial electrotherapy stimulation to treat pain associated with

spinal cord injury, pg. 461

Cranial electrotherapy stimulation (CES) sends microcurrents to the

brain via electrodes clipped to the ears. CES can effectively treat

spinal, head, dental, and muscle pain and control conditions associated

with pain (anxiety, depression, insomnia, and stress). We studied how

daily 1-hour active CES or sham CES treatment for 21 days affected pain

in 38 males with spinal cord injury (SCI). The active CES group reported

significantly greater decreases in daily pain intensity than the sham

CES group. Our results suggest that CES can effectively treat chronic

pain in people with SCI. We also found that people with SCI can and will

use the CES device at home for a 3-week period.

Race/ethnicity: Who is counting what? pg. 475

We examined the racial/ethnic classifications of 1,084 veterans with

stroke in Florida who received inpatient and outpatient services within

the Department of Veterans Affairs (VA) healthcare system. We compared

the reliability of racial/ethnic classifications from the VA inpatient

data with the VA outpatient data and the VA data with Medicare data.

Misclassification of race/ethnicity in research data may produce

spurious conclusions if overlooked or ignored. Our results showed that

the rate of unknown racial/ethnic classification in VA outpatient and

inpatient data was high. We also found that black and white

classifications in the VA data had stronger agreement with Medicare data

and Medicare data may underrepresent Hispanic patients. Minimizing the

unknowns by substituting known values from other data when available

would greatly enhance the overall and individual classification reliability.

Treadmill training with harness support: Selection of parameters for

individuals with poststroke hemiparesis, pg. 485

Locomotor training with a treadmill and harness support is a promising,

task-oriented approach to restoring gait function in individuals with

poststroke hemiparesis. Considerable latitude exists in the application

of locomotor training, and training protocols vary widely between

experimenters and clinical settings. Recent studies indicate that the

prescription of certain parameters, including body-weight support and

treadmill speed, can affect treatment outcome in hemiparetic

individuals. We reviewed the literature for studies that quantified the

immediate effects of adjusting body-weight support, treadmill speed,

support stiffness, and handrail hold during treadmill walking in

hemiparetic and nondisabled subjects. We then summarized results from

personal investigations of these parameters. Based on the currently

available evidence, we discuss the scientific rationale for selecting

certain training parameters for individuals with poststroke hemiparesis

and outline future directions for research.

Caregiver distress in parkinsonism, pg. 499

We examined the frequency and degree of caregiver burden in persons with

parkinsonism (PWP). Supporting the functioning of caregivers is vital

for the successful medical management of individuals with chronic

illness and disability. Associations between perceived caregiver burden

and physical, cognitive, and functional impairments were assessed with

well-established tools for PWP. Caregiver burden was significantly

negatively associated with activities of daily living and motoric

difficulties, self-reported sleep, and caregiver coping ability. Results

did not demonstrate an association among mentation, behavior, and mood

or between patients' self-reported pain and caregiver burden. An

improved understanding of the severity and correlates of caregiver

burden in PWPs may allow clinicians to better prioritize treatment

strategies for PWP and be more aware of the caregivers' needs.

A noncontact sensor for measurement of distal residual-limb position

during walking, pg. 509

We developed a noncontact means of measuring position of the

residual-limb surface relative to the distal prosthetic socket during

walking in a transtibial amputee so the amount of slip, or pistoning,

between a limb and socket with different suspension systems for

different activities could be evaluated. Results showed an average of

41.7 mm of displacement during swing phase relative to stance phase. A

rest period caused the limb to displace in the socket approximately 4.8

mm during subsequent walking trials, possibly reflecting limb

enlargement and thus a more proximal position in the socket after the

rest period. This sensor could be used to identify systems that decrease

limb-socket movement since excessive pistoning might detrimentally

affect socket fit.

Acclimatization in wide dynamic range multichannel compression and

linear amplification hearing aids, pg. 517

We studied acclimatization in hearing-impaired patients with no previous

hearing aid (HA) experience who were fit bilaterally with either wide

dynamic range multichannel compression (WDRMCC) or linear amplification

(LA) HAs. Throughout 32 weeks of normal HA use, we monitored changes in

nonsense syllable perception in speechspectrum noise. Syllable

recognition for WDRMCC users improved by 4.6% over the first 8 weeks,

but the 2.2% improvement for LA users was complete in 2 to 4 weeks.

Consonant confusion analyses indicated that WDRMCC experience

facilitated consonant identification, while LA users primarily changed

their response biases. These results provide evidence for

acclimatization in new users of WDRMCC HAs but not in new users of LA

HAs. Acclimatization depended on the type of amplification and on the

previous amplification experience.

Perceptual training improves syllable identification in new and

experienced hearing aid users, pg. 537

We investigated the effects of perceptual training on speech processing

in new and experienced hearing aid (HA) users with sensorineural hearing

loss. New HA users were randomly assigned to immediate training (IT) or

delayed training (DT) groups. IT subjects underwent 8 weeks of syllable

identification training and in-laboratory testing, whereas DT subjects

underwent identical in-laboratory testing without training. Training

produced large improvements in syllable identification in the IT group,

whereas untrained DT group showed minimal improvement. DT group then

underwent training and showed performance improvements comparable with

IT subjects. We also tested experienced HA users using identical

training and testing procedures as those used for new HA users. The

experienced users also showed significant performance improvements.

Perceptual training appears to be a promising tool for improving speech

perception in all HA users.

Interface pressure and cutaneous hemoglobin and oxygenation changes

under ischial tuberosities during sacral nerve root stimulation in

spinal cord injury, pg. 553

We studied how neuromuscular stimulation through a magnetic coil and a

sacral anterior root stimulator (SARS) implant (used for bladder

emptying) affects pressure and skin blood circulation under the ischial

tuberosities (ITs) of participants with spinal cord injury (SCI). The

ITs are the most common site for pressure ulcers among wheelchair users

with SCI. With optimal stimulation through a magnetic coil, average IT

peak pressure and gradient at peak pressure decreased significantly in

five seated participants with SCI. Similar results were achieved in six

seated participants with SCI during sacral nerve stimulation through

their SARS implants. Results indicated that stimulation caused enough

gluteal muscle contraction to significantly change the participants'

pressures while they sat. In addition, long-term stimulation through a

SARS implant may build up the gluteal muscles and help prevent or reduce

pressure ulcers in people with SCI.

Antinociceptive effect of linear polarized 0.6 to 1.6 ìm irradiation of

lumbar sympathetic ganglia in chronic constriction injury rats, pg. 565

Linear polarized near-infrared light has been used to treat various

painful disorders. We examinedthe effects of irradiation applied to an

area near the lumbar sympathetic ganglia on the ligated side in a

chronic constriction injury model in rats, which is believed to be an

animal model of complex regional pain syndrome (CRPS). We believe the

results of this study are relevant to the effect of irradiation for

patients with upper-limb CRPS: that irradiation near the lumbar

sympathetic ganglia of the rat is effective for thermal, but not

mechanical, pain.

Skin and bone integrated prosthetic pylon: A pilot animal study, pg. 573

Direct skeletal attachment of limb prostheses is an alternative to

traditional techniques based on a socket-residuum attachment. We

investigated cell adhesion and penetration into the pores of a porous

titanium pylon in rats. We hypothesized that the risk of skin infection

during direct attachment of limb prostheses might be reduced with this

type of pylon. Electronic scanning and morphological analysis showed

that the porous titanium pylon integrated with the surrounding skin.

Therefore, developing a natural barrier against the infection associated

with direct skeletal attachment of limb prostheses may be possible. We

preliminarily conclude that the experimental porous pylon provided an

inviting environment for the surrounding tissues.

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