A Delphi Study to Develop a National Survey of Accessibility of Medical Instrumentation

The RERC on Accessible Medical Instrumentation evaluates and develops methods and technologies to increase accessibility and usability of diagnostic, therapeutic, and procedural healthcare equipment, and associated assistive technologies, for people with disabilities. This paper outlines the Delphi approach used to develop a national consumer survey aimed at identifying key types of medical instrumentation that present problems for individuals with a wide array of disabilities. The iterative nature of the Delphi technique allowed for feedback from 30 key informants/experts with disabilities and provided a framework for further refinement of the survey. Some medical instrumentation identified in the national survey will be targeted for modification in future research and development activities of this RERC

Adults with Disabilities in Medi-Cal: The Beneficiary Perspective

Medi-Cal provides health care coverage to nearly 750,000 Californians with disabilities. Care is delivered to this population through one of two primary delivery systems: traditional fee for service and managed care. To date, there has been a lack of information about how well the program is doing at delivering health care services to people with disabilities through either delivery system. In light of recent proposals to expand Medi-Cal managed care for people with disabilities, the California HealthCare Foundation commissioned the Center for Disability Issues and the Health Professions to conduct a series of focus groups to solicit direct input from people with disabilities and their families. Based on input from the study focus groups, there appear to be significant problems in both the Medi-Cal fee-for-service and managed care delivery systems in providing services to beneficiaries with disabilities. Focus group participants in both systems expressed an almost universal lack of understanding about Medi-Cal benefits, services, and grievance procedures. Across the board, participants reported difficulty finding physicians and adequately accessing services, programs, and facilities. Nearly all participants reported difficulty in locating a primary care physician, but it appears to be slightly easier for those in managed care plans to find a primary care physician. All focus group participants, regardless of service model, expressed difficulty with locating specialists. Some of the barriers identified through this study may be unique to the Medi-Cal program, while others are likely to be indicative of problems that all people with disabilities experience, regardless of the type of health insurance they have

The effect of static stretch and warm-up exercise on hamstring length over the course of 24 hours.

STUDY DESIGN: Experimental pretest-posttest control design. OBJECTIVES: The purpose of the study was twofold: (1) to determine the lasting effect of static stretch on hamstring length for up to 24 hours and (2) to compare the efficacy of static stretch with and without warm-up exercise on hamstring length. BACKGROUND: Research is limited on the lasting effects of static stretching and is controversial on the combined effects of warm-up activities and static stretching on muscle lengthening. METHODS AND MEASURES: Fifty-six volunteer subjects (ages 18-42 years) with limited bilateral hamstring length were assigned to 1 of 4 groups: (1) warm-up and static stretch, (2) static stretch only, (3) warm-up only, and (4) control. The warm-up was 10 minutes of stair climbing at 70% of maximum heart rate. Static stretch consisted of a single session of three 30-second passive stretches of the hamstring. Hamstring length was measured preintervention and at several intervals postintervention (immediately and then at 15 minutes, 60 minutes, 4 hours, and 24 hours) using the active knee extension (AKE) test. Data were analyzed using a mixed-model analysis of variance. RESULTS: The warm-up-and-static-stretch group and the static-stretch-only group showed a significant increase in hamstring length between preintervention and all postintervention measurements. At 24 hours poststretch, the warm-up-and-static-stretch group had a mean increase of 10.3 degrees (95% confidence interval, 7.7-12.9) and the static-stretch-only group had a mean increase of 7.7 degrees (95% confidence interval, 4.7-10.7) in AKE range of motion (ROM). Both of these groups did show significant decrease (2.9 degrees and 4.0 degrees, respectively) in hamstring muscle length (AKE ROM) at 15 minutes poststretch when compared to immediate poststretch values. The static-stretch-only and the warm-up-and-static-stretch groups did not differ significantly from each other. Control and warm-up-only groups showed no significant increase in hamstring length between preintervention and any of the postintervention measurements. CONCLUSIONS: A significant increase in hamstring length can be maintained for up to 24 hours when using static stretching. Muscle length gains are greatest immediately after stretching and decline within 15 minutes. The addition of a warm-up exercise prior to stretching does not appear to significantly increase the effectiveness of static hamstring stretching

The Effect of a Neoprene Shoulder Stabilizer on Active Joint-Reposition Sense in Subjects With Stable and Unstable Shoulders.

OBJECTIVE: To compare the effects of shoulder bracing on active joint-reposition sense in subjects with stable and unstable shoulders. DESIGN AND SETTING: Two subject groups, with stable and unstable shoulders, participated in an active joint-reposition test of the shoulder under braced and unbraced conditions. SUBJECTS: Forty subjects (22 men, 18 women; age = 21.85 +/- 3.12 years; height = 173.97 +/- 10.08 cm; weight = 71.27 +/- 11.68 kg) were recruited to participate in this study. Twenty Division I athletes were referred to us for shoulder instability, which was subsequently confirmed with clinical assessment. The remaining 20 subjects were recruited from a similar student population and assessed as having stable shoulders. MEASUREMENTS: Each subject\u27s ability to perceive joint position sense in space was tested by actively reproducing 3 preset angles (10 degrees from full external rotation, 30 degrees of external rotation, and 30 degrees of internal rotation) with and without a shoulder brace. Full, active external-rotation range of motion was assessed before active joint-reposition sense testing. RESULTS: While wearing the shoulder brace, the group with unstable shoulders demonstrated significant improvement in the accuracy of active joint repositioning at 10 degrees from full external rotation in comparison with the stable group. Furthermore, those with unstable shoulders demonstrated significantly less full external rotation than did those with stable shoulders, and the brace reduced full external rotation only for those with stable shoulders. CONCLUSIONS: Our findings suggest that shoulder active joint-reposition sense in subjects with unstable shoulders can be improved at close to maximal external rotation by wearing a shoulder brace. This effect does not appear to be related to restriction of shoulder external rotation