Development and validation of the Self-Management Assessment for the Residuum and prosThesis (S.M.A.R.T.)

Background: Self-management is the process of preventing complications through meticulous self-care and vigilant self-inspection. Persons with long-term impairments or diseases must follow an effective self-management routine as part of their care regimen to reduce the risk of injury. Assessment of knowledge as it relates to self-management is standard care forpersons with chronic disease and long-term impairments. Identifying knowledge gaps allows for patient-centered educational interventions to be targeted to the person’s area of deficit. Despite the importance of self-management in persons with limb loss, there is currently no valid and reliable way to objectively assess knowledge specific to this population. Purposes: The purposes of this dissertation study were to develop and validate a reliable knowledge assessment measure and corresponding set of targeted educational interventions that are specific to the lower limb loss population, and to describe theexperiences of prosthetic users as it relates to self-management. Methods: This dissertation study took place in four phases and utilized mixed methodology. Phase 1 involved a needs assessment of relevant stakeholders through semi-structured interviews. Phase 2 was development of the knowledge assessment measure, face validation, and content validation of that measure. Phase 3 assessed reliability using Kuder-Richardson Formula 20 (KR-20), item difficulty, and structure of the measure based on corrected total-item correlations. Phase 4 evaluated the discriminate construct validity of the measure using known groups. Results: Four prominent themes relating to self-management were established from the codes of interviewed prosthetic users, supported through triangulation of interviewed prosthetists and physical therapists. The themes were: self-management(1) requires embodiment of responsibility, (2) requires vigilance and self-advocacy, (3) is a process facilitated through education and support, and (4) requires decision-making. Reliability of the drafted 60-item measure was good at KR-20=.72, however alternative forms were found to have superior or similar internal consistency ranging from KR-20=.70-.82. Face validity was high at a mean 4.49±.15/5.0 (90%) for the measure’s readability, usability, perceived utility, and benefit to stakeholders. All versions ofthe measure had discriminate construct validity (p\u3c.05). Conclusion: The knowledge assessments developed in this dissertation study are both valid and reliable for persons with lower limb loss. For new prosthetic users, a short 14-item version can be used as a quick screen in the clinic to assess self-management knowledge, while sub-modules and the 45-item comprehensive assessment allows for a progressive depth ofexamination. The measures can be utilized in the clinic to identify gaps in self-management related knowledge

The Smartphone Brain Scanner: A Portable Real-Time Neuroimaging System

Combining low cost wireless EEG sensors with smartphones offers novel opportunities for mobile brain imaging in an everyday context. We present a framework for building multi-platform, portable EEG applications with real-time 3D source reconstruction. The system - Smartphone Brain Scanner - combines an off-the-shelf neuroheadset or EEG cap with a smartphone or tablet, and as such represents the first fully mobile system for real-time 3D EEG imaging. We discuss the benefits and challenges of a fully portable system, including technical limitations as well as real-time reconstruction of 3D images of brain activity. We present examples of the brain activity captured in a simple experiment involving imagined finger tapping, showing that the acquired signal in a relevant brain region is similar to that obtained with standard EEG lab equipment. Although the quality of the signal in a mobile solution using a off-the-shelf consumer neuroheadset is lower compared to that obtained using high density standard EEG equipment, we propose that mobile application development may offset the disadvantages and provide completely new opportunities for neuroimaging in natural settings

A Clinical Guide to the Psychosocial Issues Related to Pediatric Traumatic Brain Injuries

Children and adolescents who sustain a traumatic brain injury (TBI) demonstrate changes in personality, such as mood swings, irritability, impulsivity, argumentative behaviors, decreased frustration tolerance, and difficulty cooperating (Prigatano & Gray, 2007; Prigatano & Gray, 2008; Souza, Braga, Filho, & Dellatolas, 2007). These clients also have an increased susceptibility to psychiatric disorders, including mood and anxiety disorders, later in the lifespan as physical and cognitive demands increase (Koponen et al., 2002; Luis & Mittenberg, 2002; Viguier, Dellatolas, Gasquet, Martin, & Choquet, 2001). Despite these substantial risk factors, a significant number of children and adolescents continue to have unrecognized or unmet behavioral, emotional, and social needs as a result of inadequate mental health services (Greenspan & MacKenzie, 2000; Hawley, 2004; Slomine, McCarthy, Ding, MacKenzie, Jaffe, Aitken, et al., 2006; Souza et al., 2007). Therefore, the purpose of this scholarly project was the development of a clinical guide for occupational therapy (OT) practitioners in pediatric rehabilitation settings that provides a framework to address psychosocial issues experienced by pediatric clients with TBIs. An extensive review of developmental, educational, medical, psychological, occupational therapy, and rehabilitation literature was conducted to examine the psychosocial symptoms associated with pediatric TBI. Subsequently, the impact depression and mood disorders, personality and cognitive-behavioral changes, impaired social skills, and decreased self-esteem/self-efficacy have on occupational functioning was considered. The need for OT programs to address psychosocial impairments with pediatric clients who have sustained a TBI was supported by findings that there is a high unmet need for services that address mental health issues following a head injury (Greenspan & MacKenzie, 2000; Hawley, 2004). As a result of the literature findings, a clinical guide for OT practitioners was created to help practitioners incorporate psychosocial issues into the evaluation, intervention planning, and intervention implementation processes. The clinical guide encompasses information regarding relevant background information on TBI, psychosocial symptoms, OT practitioner’s holistic role in addressing psychosocial symptoms, pediatric psychosocial assessments, sample goals, and interventions that address psychosocial deficits. The OT Practice Framework, 2nd ed. (2008), Occupational Adaptation frame of reference, and the adult learning theory were used to help structure the clinical guide in a manner that is meant to assist OT practitioners through the clinical reasoning process in providing holistic, client-centered care to the pediatric client and his or her family. Reproducible handouts, including educational materials for family members and school professionals, were also provided in a workbook format

Trade-off between formal and informal care in Spain

The remarkable growth of older population has moved long term care to the front ranks of the social policy agenda. Understanding the factors that determine the type and amount of formal care is important for predicting use in the future and developing long-term policy. In this context we jointly analyze the choice of care (formal, informal, both together or none) as well as the number of hours of care received. Given that the number of hours of care is not independent of the type of care received, we estimate, for the first time in this area of research, a sample selection model with the particularity that the first step is a multinomial logit model. With regard to the debate about complementarity or substitutability between formal and informal care, our results indicate that formal care acts as a reinforcement of the family care in certain cases: for very old care receivers, in those cases in which the individual has multiple disabilities, when many care hours are provided, and in case of mental illness and/or dementia. There exist substantial differences in long term care addressed to younger and older dependent people and dependent women are in risk of becoming more vulnerable to the shortage of informal caregivers in the future. Finally, we have documented that there are great disparities in the availability of public social care across regions.Formal care, informal care, caregiver, dependent

Assistive technology design and development for acceptable robotics companions for ageing years

© 2013 Farshid Amirabdollahian et al., licensee Versita Sp. z o. o. This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivs license, which means that the text may be used for non-commercial purposes, provided credit is given to the author.A new stream of research and development responds to changes in life expectancy across the world. It includes technologies which enhance well-being of individuals, specifically for older people. The ACCOMPANY project focuses on home companion technologies and issues surrounding technology development for assistive purposes. The project responds to some overlooked aspects of technology design, divided into multiple areas such as empathic and social human-robot interaction, robot learning and memory visualisation, and monitoring persons’ activities at home. To bring these aspects together, a dedicated task is identified to ensure technological integration of these multiple approaches on an existing robotic platform, Care-O-Bot®3 in the context of a smart-home environment utilising a multitude of sensor arrays. Formative and summative evaluation cycles are then used to assess the emerging prototype towards identifying acceptable behaviours and roles for the robot, for example role as a butler or a trainer, while also comparing user requirements to achieved progress. In a novel approach, the project considers ethical concerns and by highlighting principles such as autonomy, independence, enablement, safety and privacy, it embarks on providing a discussion medium where user views on these principles and the existing tension between some of these principles, for example tension between privacy and autonomy over safety, can be captured and considered in design cycles and throughout project developmentsPeer reviewe

Learning, Arts, and the Brain: The Dana Consortium Report on Arts and Cognition

Reports findings from multiple neuroscientific studies on the impact of arts training on the enhancement of other cognitive capacities, such as reading acquisition, sequence learning, geometrical reasoning, and memory

THE INFLUENCE OF CONTEXTUAL FACTORS ON COMMUNITY REINTEGRATION AMONG SERVICE MEMBERS INJURED IN THE GLOBAL WAR ON TERRORISM

Community reintegration among military service members with physical and psychological injuries sustained during combat has been an emerging issue since the beginning of the Global War on Terror (GWOT) in 2001. Injured service members from the GWOT, including Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn, are much more likely to survive their injuries when compared to previous wars such as the Vietnam War and World War II (Holcomb, Stansbury, Champion, Wade, & Bellamy, 2006). Therefore, many more injured service members are receiving physical rehabilitation and mental health services to assist them in transitioning back into their homes and communities. Recent studies have indicated that injured service members are at risk of poor community reintegration (Resnik & Allen, 2007; Resnik, Plow, & Jette, 2009). However, these studies have neglected to account for personal and environmental factors (e.g., contextual factors) that influence community reintegration. These contextual factors have the potential to greatly affect an injured service members ability to reintegrate (Resnik et al., 2012). Therefore, the purpose of this mixed methods study was to identify and explain the influence of contextual factors on community reintegration among service members who have sustained physical and/or psychological injuries while serving in the GWOT

Hospitalized older adults' experiences of virtual reality-based group exercise therapy with cycle ergometers:An early feasibility study

Sedentary behavior among hospitalized older adults is a well-described challenge that can increase the risk of loss of function and mortality. Therefore, it is important to encourage physical activity (PA) during hospitalization. Exertion Games (exergames) have repeatedly been suggested as a tool to encourage and sustain motivation in rehabilitation programs. This article presents early findings from a convergent parallel mixed methods study that explored whether social presence and PA could be combined through the novel use of immersive virtual reality technology in a feasible group exercise constellation. Inpatients (n=10, 50% female, 80.3±8.2 years) were invited to participate in a bi-weekly VR group session. Most participants (62%) responded that it was a good experience to a large/great extent, which they would like to use repeatedly (76%). The technology was easy for untrained healthcare professionals and had minimal adverse events for the participants. However, a major finding illustrates that the enclosing immersiveness of the headset hindered conversation during exercise sessions. The exclusion of sight likely had a negative effect on forming relations between the participants, which conversely caused the participants to experience a lack of cohesion and relatedness with the other participants. VR-mediated group therapy may be a promising solution to existing physiotherapy practices since it may incorporate basic psychological needs. However, to optimize for social interaction, future systems will need to afford a higher degree of social presence, e.g., through avatar embodiment in a shared virtual environment, to support older adults' autonomous motivation for PA through social interaction and novel technologies