Expression of the adhesion G protein-coupled receptor A2 (adgra2) during Xenopus laevis development

Publication date: Available online 17 February 2018
Source:Gene Expression Patterns
Author(s): Franziska A. Seigfried, Petra Dietmann, Michael Kühl, Susanne J. Kühl
The adhesion G protein-coupled receptor A2 (Adgra2) is a seven transmembrane receptor that has been described to be a regulator for angiogenesis in mice. Furthermore, the zebrafish ouchless mutant is unable to develop dorsal root ganglia through a disrupted trafficking of Adgra2. Besides RNA sequencing data, nothing is reported about Adgra2 in the south African crawled frog Xenopus laevis.In this study, we investigated for the first time the spatio-temporal expression of adgra2 during early Xenopus embryogenesis in detail. In silico approaches showed that the genomic adgra2 region as well as the Adgra2 protein sequence is highly conserved among different species including Xenopus. RT-PCR experiments confirmed that embryonic adgra2 expression is primarily detected at the beginning of neurulation and is then present throughout the whole Xenopus embryogenesis until stage 42. Whole mount in situ hybridization approaches visualized adgra2 expression in many tissues during Xenopus embryogenesis such as the cardiovascular system including the heart, the migrating neural crest cells and the developing eye including the periocular mesenchyme. Our results indicate a role of Adgra2 for embryogenesis and are a good starting point for further functional studies during early vertebrate development.



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The paleoecology of Pleistocene birds from Middle Bed II, at Olduvai Gorge, Tanzania, and the environmental context of the Oldowan-Acheulean transition

Publication date: Available online 17 February 2018
Source:Journal of Human Evolution
Author(s): Kari A. Prassack, Michael C. Pante, Jackson K. Njau, Ignacio de la Torre
Fossil bird data (community composition and taphonomic profiles) are used here to infer the environmental context of the Oldowan-Acheulean transitional period at Olduvai Gorge, Tanzania. This is the first comprehensive report on the Middle Bed II avifauna and includes fossils excavated by the Olduvai Geochronology and Archaeology Project (OGAP) and recently rediscovered fossils collected by Mary Leakey. Crane, ibis, darter, owl, raptor, crow, and vulture are reported from Bed II for the first time. The presence of these taxa, absent earlier in this Bed, point to a general opening and drying of the landscape with grassland and open woodland expansion. Taxa associated with dense, emergent wetland vegetation, such as dabbling ducks and rails, are uncommon and less diverse than earlier in Bed II. This suggests more mature wetlands with clearer waters. Cormorants continue to be common, but are less diverse. Cormorants and other roosting taxa provide evidence of trees in the area. Compared to lowermost Bed II, the Middle to Upper Bed II landscape is interpreted here as more open and drier (but not necessarily more arid), with matured wetlands, scattered trees, and a greater expansion of grasslands.



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Soft robotic devices for hand rehabilitation and assistance: a narrative review

The debilitating effects on hand function from a number of a neurologic disorders has given rise to the development of rehabilitative robotic devices aimed at restoring hand function in these patients. To comb...

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Detection of acute and long-term effects of concussion: dual-task gait balance control vs. computerized neurocognitive test

Publication date: Available online 16 February 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): David R. Howell, Louis R. Osternig, Li-Shan Chou
ObjectiveOur aim was to examine the acute (within 72 hours of injury) and long-term (2 months post-injury) independent associations between objective dual-task gait balance and neurocognitive measurements among adolescents and young adults with a concussion and matched controls.DesignLongitudinal case-controlSettingMotion analysis laboratoryParticipantsParticipants who sustained a concussion underwent a dual-task gait analysis and computerized neurocognitive testing within 72 hours of injury and again 2 months later. Uninjured controls also completed the same test protocol in similar time increments.InterventionsNot applicableMain Outcome MeasuresWe compared dual-task gait balance control and computerized neurocognitive test performance between groups using independent samples t-tests. Multivariable binary logistic regression models were then constructed for each testing time to determine the association between group membership (concussion vs. control), dual-task gait balance control, and neurocognitive function.ResultsNinety-five participants completed the study, 51 who sustained a concussion (mean age= 17.5±3.3 years; 71% male) and 44 controls (mean age= 17.7±2.9 years; 72% male). Medial-lateral center-of-mass displacement during dual-task gait was independently associated group membership at the initial test (adjusted odds ratio [aOR]= 2.432, 95% CI= 1.269-4.661) and 2 month follow-up test (aOR= 1.817, 95% CI= 1.014-3.256) tests. Visual memory composite scores were significantly associated with group membership at the initial hour post-injury time point (aOR= 0.953, 95% CI= 0.833-0.998). However, the combination of computerized neurocognitive test variables did not predict dual-task gait balance control for concussion participants, and no single neurocognitive variable was associated with dual-task gait balance control at either testing time.ConclusionsDual-task assessments concurrently evaluating gait and cognitive performance may allow for the detection of persistent deficits beyond those detected by computerized neurocognitive deficits alone.



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Home-based neuromuscular electrical stimulation as an add-on to pulmonary rehabilitation does not provide further benefits in patients with chronic obstructive pulmonary disease: A multicenter randomized trial

Publication date: Available online 16 February 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Tristan Bonnevie, Francis-Edouard Gravier, David Debeaumont, Catherine Viacroze, Jean-François Muir, Antoine Cuvelier, Marie Netchitaïlo, Anne Laure Roy, Jean Quieffin, Marie-Hélène Marques, Clément Médrinal, Johan Dupuis, Catherine Tardif
ObjectiveTo assess the additional effect of a home-based neuro muscular electrical stimulation (NMES) program as an add-on to pulmonary rehabilitation (PR), on functional capacity in subjects with chronic obstructive pulmonary disease (COPD).DesignSingle-blind, multicenter randomized trial.SettingThree PR centers.ParticipantsSubjects with severe to very severe COPD referred for PR (n=73; median FEV1, 1 (0.8-1.4) L). Twenty-two subjects discontinued the study but only one drop-out was related to the intervention (leg discomfort).InterventionSubjects were randomly assigned to either PR plus quadricipital home-based NMES (35Hz, 30min, five time per week) or PR without NMES for 8 weeks.Main outcome measureThe six-minute walk test was used to assess functional capacity.ResultsEighty-two percent of the scheduled NMES sessions were performed. In the whole sample, there were significant increases in the distance walked during the 6MWT (p<0.01), VO2peak (p=0.02), Wmax (p<0.01), mMRC (p<0.01) and SGRQ total score (p=0.01). There was no significant difference in the magnitude of change for any outcome between groups.ConclusionsHome-based NMES as an add-on to PR did not result in further improvements in subjects with severe to very severe COPD, moreover, it may have been a burden for some patients.



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Novel Interventions to Reduce Stress and Overeating in Overweight Pregnant Women: A Feasibility Study

Abstract

Background High stress and depression during pregnancy are risk factors for worsened health trajectories for both mother and offspring. This is also true for pre-pregnancy obesity and excessive gestational weight gain. Reducing stress and depression may be one path to prevent excessive caloric intake and gestational weight gain. Study Purpose We tested the feasibility of two novel interventions aimed at reducing stress and overeating during pregnancy. Reflecting different theoretical underpinnings, the interventions target different mechanisms. Mindful Moms Training (MMT) uses mindfulness to improve awareness and acceptance of experiences and promote conscious rather than automatic behavior choices. Emotional Brain Training (EBT) uses active coping to change perceptions of negative experience and promote positive affective states. Methods Forty-six overweight/obese low-income women were assigned to either MMT (n = 24) or EBT (n = 22) for an 8-week feasibility study. Pre-post changes in perceived stress, eating and presumed mechanisms were assessed. Results Women reported high levels of stress at baseline. Both interventions were well attended and demonstrated clinically significant pre-post reductions in stress, depressive symptoms, and improved eating behaviors. MMT significantly decreased experiential avoidance, whereas EBT significantly increased positive reappraisal; these changes were marginally significantly different by group. Conclusions This feasibility study found that both interventions promoted meaningful reductions in stress and depressive symptoms and improved reported eating behaviors in a high-risk group of pregnant women. Each intervention has a potentially different pathway—acceptance for MMT and reappraisal for EBT. Larger studies are needed to test efficacy on longer term reductions in stress and overeating.

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Effects of walking trainings on walking function among stroke survivors: a systematic review

Physical function is often compromised as a result of stroke event. Although interventions propose different strategies that seek to improve stroke survivors' physical function, a need remains to evaluate walking training studies aimed at improving such physical function. The aim of this review was to assess the available literature that highlights the impact of walking training on enhancing walking for stroke survivors. We performed a systematic literature review of online databases – Google Scholar, PubMed, CINHAL, Cochrane Library, Scopus, and EBSCO – with the following inclusion criteria: manuscript published from 2005 to 2016, written in English, with treatment and control groups, for walking training studies aimed at improving physical function among stroke survivors. Findings indicated that walking speed, walking distance, and gait speed were the most used outcome variables for measuring improved physical function among stroke survivors. Importantly, proposed interventions involved either overground or treadmill walking trainings, if not both. Preserved locomotor improvements were not noted in all interventions at follow-up. Some interventions that used walking treadmill training augmented by auditory stimulations reported significant improvements in physical function compared with overground walking training augmented by auditory stimulations. The imperative to improve physical function among stroke survivors with physical impairment is paramount, as it allows survivors to be socially, emotionally, and physically more independent. In general, we note an insufficiency of research on the interaction between physical function and socialization among stroke survivors.

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Best practice guidelines for the measurement of physical activity levels in stroke survivors: a secondary analysis of an observational study

The aim of this study was to investigate the phenomenon of activity (increased activity in response to monitor wear) and determine the minimum wear time of accelerometers when objectively measuring habitual physical activity levels of community dwelling stroke survivors. Exploratory, secondary analyses of cross-sectional data were carried out. Physical activity variables [sitting, standing and stepping time, step count, light physical activity and moderate-to-vigorous physical activity (MVPA)] were measured with two activity monitors for 7 days. Repeated-measures analysis of variance was used to assess reactivity. Minimum wear time was assessed using regression analyses and median absolute differences. Paired t-tests were used to assess differences between weekend and weekday activity levels. There was no evidence of reactivity. Minimum wear time was 3 days for all activity variables, with the exception of MVPA, for which 7 days of monitoring was required. There were no significant differences in weekend and weekday activity levels. To accurately measure activity levels of individuals with stroke, we recommend 3 days of monitoring for all activity variables, with the exception of MVPA, which requires 7 days.

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Measuring quality of life in individuals with Parkinson’s disease attending a self-help club: cross-sectional study in Hungary

The prevalence of Parkinson's disease (PD) increases with aging. The aim of our cross-sectional study was to measure the quality of life of PD patients attending a self-help 'PD club' and to evaluate the potential positive effect of club life on quality of life. Data collection was carried out using questionnaires (PDQ-39, Hungarian version). Altogether, 101 individuals with clinically diagnosed PD were included, and finally 98 persons' data were analyzed. Among the eight dimensions, the highest score was found in 'bodily discomfort' and the lowest in 'social support'. The overall tendency of the results was similar to another Hungarian study, but the scores in all dimensions were significantly lower in our participants. These positive results seem to correlate with attending the 'PD club', indicating the potential beneficial effect of patients' organizations on promoting mental health.

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Developing operational items for the International Classification of Functioning, Disability and Health Rehabilitation Set: the experience from China

The International Classification of Functioning, Disability and Health (ICF) Rehabilitation Set is proposed as a tool to measure functioning among a clinical population in Chinese rehabilitation services. It needs to be applied in a transparent and reliable way and considered from a measurement perspective. The aim of this study was to develop items operationalizing the ICF Rehabilitation Set to enhance the standardized and unified assessment in varied clinical settings. A list of proposed operational items was generated by (i) linking the items of four standard assessment instruments; (ii) literature review; and (iii) self-development. The candidate operational items were then evaluated by Chinese experts in rehabilitation medicine. One hundred and sixty-six operational items were generated using the three approaches and 54 were evaluated in the formal expert survey. Finally, 30 experts validated nine items from the assessment instruments, two found in the literature and 19 self-developed items for operationalizing the ICF Rehabilitation Set. The 30 operational items validated could potentially facilitate the implementation of the ICF Rehabilitation Set in clinical settings and provide a reference point for future research.

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Comparison of mobility and user satisfaction between a microprocessor knee and a standard prosthetic knee: a summary of seven single-subject trials

Insufficient evidence of the benefits provided by costlier microprocessor knees (MPKs) over nonmicroprocessor knees (NMPKs) often causes concern when considering MPK prescription. Thus, more studies are needed to demonstrate differences between MPKs and NMPKs and define sensitive outcomes to guide MPK prescription. The aim of this study was to evaluate the impact of switching from NMPK to MPK on measures of mobility and preference. Seven long-term NMPK users (all men, ages 50–84, 3–64 years postamputation) participated in this study, which use a single-subject design (ABA or BAB; A=NMPK, B=MPK). Mobility was assessed with the Amputee Mobility Predictor, Berg Balance Scale (BBS), L-Test, 6-Min Walk Test (6MWT) with Physiological Cost Index, and self-selected normal and very fast gait speeds. The preference between NMPK and MPK was evaluated by the Prosthesis Evaluation Questionnaire (PEQ) and the visual analog scale. Mobility improved with the MPK in six of seven participants, which was most often captured with BBS (median: +6 points) and 6MWT (median: +63 m). These improvements typically exceeded minimal clinically important difference or minimal detectable change thresholds. Most participants scored the MPK higher on the PEQ (median: +20 points) and six of seven expressed a global preference toward MPK. In the BAB group, the Amputee Mobility Predictor and BBS correlated with perception of change on several PEQ domains (Ρ≥0.59). In conclusion, MPKs may provide better outcomes and user satisfaction, particularly in those with lower mobility function. BBS and 6MWT were found to be the most sensitive measures to capture changes in mobility while using MPK for several weeks.

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The Italian version of the Outpatient Physical Therapy Improvement in Movement Assessment Log: cross-cultural adaptation and psychometric properties

Instruments to measure movement abilities from a patient's perspective are generally unavailable across diverse cultures and languages. The aim of this study was to translate, culturally adapt, and validate the Italian version of the Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL) confidence scale. This study was an observational multicenter study. The Italian version of the OPTIMAL confidence scale (OPTIMAL-I) was developed following forward–backward translation and pretesting with a small group of patients. Reliability was measured by internal consistency (Cronbach α), and a factor analysis was carried out to explore the internal structure. Convergent validity was measured by comparing the OPTIMAL-I with the Italian version of the Activities-specific Balance Confidence (ABC-I). The process for obtaining the OPTIMAL-I required 3 months and it was administered to 290 outpatients in two different rehabilitation clinics. OPTIMAL-I showed high acceptability, high internal consistency (Cronbach's α=0.963), and high test–retest stability (intraclass correlation coefficient=0.92, P=0.001). Convergent validity with ABC-I was also high (r=0.56–0.86; P

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Correlation between the pain numeric rating scale and the 12-item WHO Disability Assessment Schedule 2.0 in patients with musculoskeletal pain

Objective The aim of this study was to assess the correlation between pain severity measured on a numeric rating scale and restrictions of functioning measured with the WHO Disability Assessment Schedule (WHODAS 2.0). Patients and methods This was a cross-sectional study of 1207 patients with musculoskeletal pain conditions. Correlation was assessed using Spearman's and Pearson tests. Results Although all the Spearman's rank correlations between WHODAS 2.0 items and pain severity were statistically significant, they were mostly weak, with only a few moderate associations for 'S2 household responsibilities', 'S8 washing', 'S9 dressing', and 'S12 day-to-day work'. The correlation between the WHODAS 2.0 total score and pain severity was also moderate: 0.41 [95% confidence interval (CI): 0.36–0.45] for average pain and 0.42 (95% CI: 0.37–0.46) for worst pain. The correlation between the WHODAS 2.0 total score and pain level was also assessed using Pearson's product–moment correlation, yielding figures that were similar to Spearman's correlation: 0.42 (P

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Effects of modified constraint-induced movement therapy in the recovery of upper extremity function affected by a stroke: a single-blind randomized parallel trial-comparing group versus individual intervention

An extensive corpus of literature supports the positive impact of constraint-induced movement therapy (CIMT) on neuroplasticity and the recovery of function. However, its clinical applicability is limited by the time of intervention and individual modality. We propose to assess the efficacy of modified CIMT protocols through a group therapy intervention. To determine the effectiveness of a group therapy, compared with individual modified CIMT, in increasing the use and functionality of movement of a paretic upper limb. The study was a single-blind, randomized parallel trial. Thirty-six patients who had had a stroke more than 6 months previously were divided randomly into two intervention groups. The independent variable was the implementation of group or individual modalities for 3 h for 10 consecutive days and the dependent variables were evaluated by the Motor Activity Log and Action Research Arm Test, at baseline (preintervention evaluation), end (postintervention evaluation), and 6 months after intervention (follow-up). By controlling the preintervention evaluations, analyses of covariance indicated that both dependent variables presented significant differences in favor of the group therapy at both the postintervention evaluation and the follow-up evaluations. Both types of intervention generated increases in the function and use of the upper extremity, with these increases being higher in the group therapy. The effects of the group therapy modality were maintained 6 months after the intervention ended.

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Effects of integrating rhythmic arm swing into robot-assisted walking in patients with subacute stroke: a randomized controlled pilot study

This study aimed to identify the effects of rhythmic arm swing during robot-assisted walking training on balance, gait, motor function, and activities of daily living among patients with subacute stroke. Twenty patients with subacute stroke were recruited, and thereafter randomly allocated to either the experimental group that performed the robot-assisted walking training with rhythmic arm swing, or the control group that performed the training in arm fixation. In total, 30 training sessions were carried out. The outcome measures included the 10-m walk test, Berg balance scale, timed up-and-go test, fall index that was measured using the Tetrax system, motor function test of Fugl-Meyer assessment, and modified Barthel index. The patients of both groups showed significant improvement in all parameters after the intervention (P

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Alanine aminotransferase blood levels and rehabilitation outcome in older adults following hip fracture surgery

Low alanine aminotransferase (ALT) blood levels are associated with frailty and poor outcome in older adults. Therefore, we studied the association between ALT blood levels before rehabilitation and rehabilitation outcome in older adults following hip fracture surgery. A total of 490 older adults (age>60 years, mean age: 82.9±6.7 years, 82.0% women) admitted to rehabilitation following hip fracture surgery were included. The rehabilitation outcome was assessed by Functional Independence Measure (FIM) scores. ALT blood levels were documented between 1 and 6 months before rehabilitation. Patients with ALT blood levels over 40 IU/l possibly consistent with liver injury were excluded. The cohort was divided into two groups: patients with ALT more than 10 IU/l and patients with ALT less than or equal to 10 IU/l. Upon rehabilitation discharge, the FIM outcome measures (motor, cognitive, gain, efficiency) were significantly higher in patients with ALT more than 10 IU/l relative to patients with ALT less than or equal to 10 IU/l (P50), cognitive FIM scores (>16), and FIM efficiency (>0.228) upon rehabilitation discharge (odds ratio=1.56–1.78). However, this association was no longer significant following adjustment also for admission total FIM score, cognitive impairment, cancer, and albumin serum levels. High-normal ALT blood levels before rehabilitation are associated with a better rehabilitation outcome in older adults following hip fracture surgery. It may be used when data on admission FIM score, cognitive impairment, cancer, and albumin serum levels are not available.

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Effects of rehabilitation aftercare on work participation in patients with musculoskeletal disorders: a propensity score-matched analysis

Meta-analyses of rehabilitation studies in chronic back pain patients in Germany showed a lack of sustainability of rehabilitation programs. The German Pension Insurance therefore developed an intensified aftercare program to support rehabilitation outcomes. The aim of this study was to compare disability pension rates, income from regular employment, and duration of welfare benefits in patients with and without rehabilitation aftercare. We used administrative data on finished rehabilitation services. Patients were included if they were aged 18–60 years, had musculoskeletal disorders, and attended an outpatient or an inpatient rehabilitation program during the first term of 2007. Patients were excluded if they received an old-age pension, started a disability pension before January 2008, or died during the follow-up period. Patients with rehabilitation aftercare were matched by propensity scores with patients without rehabilitation aftercare. Estimation of the propensity score considered 20 potential confounders. There were no differences in the cumulative probability of receiving a disability pension. Moreover, patients with and without aftercare did not differ in their income from regular employment and the duration of different types of welfare benefits during the follow-up period. However, stratified analyses found a positive effect of an aftercare program on income in patients who attended a postacute rehabilitation program and patients who were at least 3 months absent because of sickness during the year preceding the initial rehabilitation program. Only patients with strong impairments benefit from attending an aftercare program. Allocation to aftercare programs and the focus on exercise only have to be reconsidered and revised.

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Are rehabilitation outcomes after severe anoxic brain injury different from severe traumatic brain injury? A matched case–control study

Many reports have investigated rehabilitation outcomes after a traumatic brain injury (TBI); however, comparably less is known about whether they differ from outcomes of an anoxic brain injury (ABI). Thus, we aimed to compare the rehabilitation outcomes of patients with ABI with control patients who have TBI. Forty participants with ABI and 40 participants with TBI were included in this retrospective study. Participants with ABI were matched with participants with TBI who had similar clinical characteristics such as age, initial Functional Independence Measurement (FIM) score, and duration of coma. FIM and Functional Ambulation Classification (FAC) scores on rehabilitation admission and on rehabilitation discharge were recorded. The FIM score in the ABI group was 41.7±28.5 on rehabilitation admission and increased to 57.1±31.4 on rehabilitation discharge. The FIM score in the TBI group was 40.8±24.0 on rehabilitation admission and increased to 65.9±35.3 on rehabilitation discharge. There was no statistically significant difference in the FIM scores on rehabilitation discharge between groups. Initial FAC was similar in both groups and there was no statistically significant difference in the FAC scores on rehabilitation discharge. The multiple linear regression analysis showed that intensive care unit length of stay had an inverse relationship with the FAC change. We did not find significant differences in the rehabilitation outcomes of participants with ABI compared with participants with TBI. Considering the lack of information in the literature on ABI rehabilitation, this study may be important to guide rehabilitation teams.

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Examination of the reliability of Gait Assessment and Intervention Tool in patients with a stroke

The Gait Assessment and Intervention Tool (GAIT) has been recently developed for gait assessment in patients with stroke, and it is considered as a tool that may identify clinically relevant deviations from normal gait and quantifies relevant changes in gait because of an intervention. The objective was to analyze the GAIT psychometric properties in participants with stroke. A convenience sample of 15 adults with stroke was selected (58.15±7.8 years; 5.38±3.3 years from injury). We used the GAIT for evaluating the gait in patients with stroke. GAIT scoring is based on observations of anterior/posterior and lateral-view video documents. Inter-rater reliability of the GAIT between trained raters was good (intraclass correlation coefficient=0.762; P=0.008; 95% confidence interval=0.749–0.926). The minimal detectable change was 7.68 points (12.39%). Inter-rater reliability for the hip, knee, and ankle items was also good. In conclusion, the current study demonstrated that GAIT has good inter-rater reliability and good internal consistency.

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Prevalence and correlations between suicide attempt, depression, substance use, and functionality among patients with limb amputations

Most patients undergoing limb amputations suffer significant emotional changes. The aim of this study was to estimate the prevalence of suicide attempts and depression in a sample of Mexican patients with limb amputations and, second, to determine whether the patients' functionality correlates with the presence of depression. We studied 40 patients who had undergone a limb amputation. The suicide attempt was evaluated using the Suicide Intent Scale. The depression was assessed using the Hamilton Depression Rating Scale, whereas the functionality of the patients was measured using the Functional Independence Measure. In this sample, 90% were men, whereas only 10% were women. In terms of the suicide behavior, we identified suicide attempts in 27.5% of the patients. The rate of depression was 92.5%. In the Functional Independence Measure, we observed that 57.5% of the patients showed complete dependence. Finally, a significant correlation was found between depression and functionality (r=−0.75, P

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Use of clinical measures to document the effect of passive cycling on knee extensor spasticity and the ability to perform activities of daily living in spinal cord injury: a case report

The effects, on spasticity-related clinical measure results [initial knee flexion velocity during the pendulum test (F1-VEL); Spinal Cord Injury Spasticity Evaluation Tool (SCI-SET) scores], of a 5-week passive cycling program were assessed in a 67-year-old man with chronic, complete, thoracic-level SCI. Three weekly evaluations were performed before and after training, at the start, middle, and end of the training (ET), and 24 h following ET. The F1-VEL increased significantly from baseline, from ET to the 2-week follow-up evaluation. A trend was found for an improvement from baseline in SCI-SET scores, from middle of training onwards. These findings, which can inform clinical decisions and clinical trial development, suggest that the F1-VEL pendulum test result may be used to document the effect on knee extensor spasticity of a passive cycling program in chronic, complete, thoracic-level SCI. Whether this is also true for the SCI-SET requires future confirmation.

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Healthcare Experiences of Low-Income Women with Prior Gestational Diabetes

Abstract

Introduction An important yet understudied component of postpartum type 2 diabetes risk reduction among high risk women is experiences with the healthcare system. Our objective was to describe the healthcare experiences of a diverse, low-income sample of women with prior GDM, including their suggestions for improving care. Methods Focus groups were conducted among African American, Hispanic, and Appalachian women who were diagnosed with GDM within the past 10 years. Participants were recruited from community and medical resources. Twelve focus groups were conducted, four within each race-ethnic group. Results Three broad themes were identified around barriers to GDM care, management, and follow-up: (1) communication issues; (2) personal and environmental barriers; and (3) type and quality of healthcare. Many women felt communication with their provider could be improved, including more education on the severity of GDM, streamlining information to be less overwhelming, and providing additional support through referrals to community resources. Although women expressed interest in receiving more actionable advice for managing GDM during pregnancy and for preventing type 2 diabetes postpartum, few women reported changing behaviors. Barriers to behavior change were related to cost, transportation, and competing demands. Several opportunities for improved care were elucidated. Discussion Our findings suggest that across all racial and ethnic representations in our sample, low-income women with GDM experience similar communication, personal, and environmental barriers related to the healthcare they receive for their GDM. Considering the increased exposure to the health care system during a GDM-affected pregnancy, there are opportunities to address barriers among women with GDM across different race-ethnic groups.

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