Contextual Facilitators and Barriers of Community Reintegration among Injured Female Military Veterans: A Qualitative Study

Publication date: Available online 1 September 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Brent L. Hawkins, Brandi M. Crowe
ObjectiveTo understand the facilitators and barriers to community reintegration (CR) among injured female veterans.DesignPhenomenological qualitative designSettingCommunityParticipantsCommunity-dwelling female veterans with physical and/or psychological injury (N=13).InterventionsNoneMain Outcome MeasuresNoneResultsConventional content analysis revealed three types of facilitators, including: (a) strong social supports; (b) impactful programs; and (c) protective personal beliefs. Six types of barriers included: (a) inadequate services; (b) lack of access to services; (c) poor social support; (d) difficulty trusting others; (e) non-supportive personal beliefs; and (f) injury factors.DiscussionMultiple environmental and personal factors acted as facilitators and barriers to CR. Findings are relatively consistent with previous veteran and civilian community reintegration research that indicates the importance of health-related services, attitudes of others, and social support. However, females in this study reported being impacted by many of these facilitators and barriers because of their gender.ConclusionsThis study supports the need to foster social support among injured female veterans throughout the rehabilitation process to promote CR. Long-term social support can be gained by incorporating services such as adjunctive therapies, recreation, and other social programming into the rehabilitation repertoire to help with CR for all veterans, particularly females.



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What is the longitudinal profile of impairments and can we predict difficulty caring for the profoundly-affected arm in the first year post-stroke?

Publication date: Available online 1 September 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Rhoda Allison, Cherry Kilbride, Jade Chynoweth, Siobhan Creanor, Ian Frampton, Jonathon Marsden
ObjectiveTo establish the longitudinal profile of impairments of body functions and activity limitations of the arm, and evaluate potential predictors of difficulty caring for the profoundly-affected arm post-stroke.DesignProspective cohort study.SettingThree UK stroke services.ParticipantsPeople unlikely to regain functional use of the arm (N=155) were recruited at 2-4 weeks post-stroke, and followed up at 3, 6 and 12 months. Potential predictors at baseline were hypertonicity, pain, motor control, mood, sensation/perception, age and stroke severity.InterventionsNAMain Outcome MeasuresDifficulty caring for the arm (LASIS), pain, hypertonicity, range of movement, arm function and skin integrity. Multi-variable linear regression identified the best fitting model for predicting LASIS at 12 months.ResultsOne hundred and ten participants (71%) were reviewed at one year. There was a large variation in the profile of arm functions and activity limitations. Inability or severe difficulty caring for the arm affected 29% of participants. Hypertonicity developed in 77%, with severe hypertonicity present in 25%. Pain was reported by 65%, 94% developed shoulder contracture and 6% had macerated skin. Difficulty caring for the arm increased with age, greater level of hypertonicity and stroke classification; collectively these factors accounted for 33% of the variance in LASIS.ConclusionsAt one year post-stroke, there was a high incidence of impairments of body functions and activity limitations in people with a profoundly-affected arm. Individual profiles were very variable and although some pre-disposing factors have been identified, it remains difficult to predict who is at greatest risk.



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Development of a Computerized Adaptive Test of Children’s Gross Motor Skills

Publication date: Available online 1 September 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Chien-Yu Huang, Li-Chen Tung, Yeh-Tai Chou, Hing-Man Wu, Kuan-Lin Chen, Ching-Lin Hsieh
ObjectiveThis study aimed to develop a computerized adaptive test (CAT) for gross motor skills (GM-CAT) as a diagnostic test and an outcome measure, using the gross motor subtest of the Comprehensive Developmental Inventory for Infants and Toddlers (CDIIT-GM) as the candidate item bank. Moreover, we examined the psychometric properties and the efficiency of the GM-CAT.SettingA developmental center of a medical centerDesignRetrospective study.ParticipantsChildren with and without developmental delay (N=1,738)InterventionsNot Applicable.Main Outcome MeasuresThe CDIIT-GM contains 56 universal items on gross motor skills assessing children's antigravity control, locomotion, and body movement coordination.ResultsThe item bank of the GM-CAT had 44 items that met the dichotomous Rasch model's assumptions. High Rasch person reliabilities were found for each estimated gross motor skill for the GM-CAT (Rasch person reliabilities = 0.940 ∼ 0.995, standard error = 0.68∼2.43). For children of 6 ∼ 71 months, the GM-CAT had good concurrent validity (rs = 0.97 ∼ 0.98), adequate to excellent diagnostic accuracy (area under receiver operating characteristics curve = 0.80 ∼ 0.98), and moderate to large responsiveness (effect size =0.65 ∼ 5.82). The averages of items administered for the GM-CAT were 7 to 11, depending on the age group.ConclusionsThe results of this study support the use of the GM-CAT as a diagnostic and outcome measure to estimate children's gross motor skills in both research and clinical settings.



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Long-Term Functional Outcomes in Military Service Members and Veterans after Traumatic Brain Injury/Polytrauma Inpatient Rehabilitation

Publication date: Available online 1 September 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Max Gray, Joyce Chung, Fatima Aguila, T. Gavin Williams, Jeffrey K. Teraoka, Odette A. Harris
ObjectiveTo determine the impact of the established Polytrauma/TBI infrastructure on immediate post-treatment functional gains, the long-term sustainability of any gains and participation-related community reintegration outcomes in a baseline cohort of patients eight years post-admission.DesignRetrospective review and prospective repeated measures of an inception cohort.SettingVeterans Affairs Palo Alto, Polytrauma Rehabilitation Center (PRC)Participants44 patients consecutively admitted to the PRC inpatient rehabilitation unit during its first full Fiscal Year, 2006.InterventionsThe PRC infrastructure and the formalized rehabilitation for Polytrauma/TBI.Main Outcome MeasuresFunctional Independence Measure scores at admission, discharge, 3 months and 8 years post discharge; participation-related socioeconomic factors reflecting community reintegration eight years after admission.ResultsFunctional gains were statistically significantly increased from admission to discharge. Improvements were maintained at both 3 months post-discharge and 8 years post-discharge. The socio-economic data collected at 8 year follow-up showed greater than 50% either competitively employed or continuing their education and 100% living in a non-institutionalized setting.ConclusionsThis study addresses a concern regarding the long-term functional outcomes of rehabilitation patients treated by the established infrastructure of the Polytrauma System of Care inpatient rehabilitation centers. The results suggest that Polytrauma/TBI rehabilitation care utilizing a comprehensive, integrated approach is effective and durable in achieving functional gains and successful community reintegration within our initial PRC cohort. Follow-up of subsequent FY cohorts would add to the validity of these outcome findings.



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Depression in the School-Aged Child With Type 1 Diabetes: Implications for Pediatric Primary Care Providers

Depression is a common comorbid condition experienced by children with type 1 diabetes that, if undiagnosed, can lead to deterioration in glycemic control and other serious health complications. Although it is documented that children with type 1 diabetes experience high rates of depression, a comprehensive clinical guide does not exist to help direct the pediatric provider on how to best care for these children. The purpose of this article is to synthesize current evidence to aid the pediatric primary care provider in the detection and management of depression in the school-aged child with type 1 diabetes.

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Health-Related Quality of Life Outcomes of a Telehealth Care Coordination Intervention for Children With Medical Complexity: A Randomized Controlled Trial

The purpose of this study was to explore health-related quality of life (HRQL) and family impact in the context of an advanced practice registered nurse–delivered telehealth care coordination intervention for children with medical complexity (CMC). This was a secondary outcomes analysis of a randomized controlled trial with 163 families of CMC in an existing medical home. HRQL and family impact were measured using the PedsQL measurement model. Bivariate and analysis of covariance analyses were conducted to explore associations at baseline and the intervention effect over 2 years.

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Incontinentia Pigmenti: A Summary Review of This Rare Ectodermal Dysplasia With Neurologic Manifestations, Including Treatment Protocols

Incontinentia pigmenti is a rare neuroectodermal dysplasia caused by a defect in the IKBKG gene (formerly known as NEMO). There are 27.6 new cases per year worldwide; 65% to 75% are sporadic mutations, and 25% to 35% are familial. It is usually lethal in males, but females survive because of X-inactivation mosaicism. The disorder is typically identified by unique skin findings, a series of four stages that emerge throughout the first year of life. The central nervous system manifestations in the eye and in the brain cause the most disability.

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