Sensory Changes in Adults with Unilateral Transtibial Amputation

The purpose of this study was to describe the sensory changes in adults with unilateral transtibial amputation (TTA), as any loss of sensation may have significant impact on the successful use of a prosthesis. Sensory modalities of light touch, deep pressure, vibration, and superficial pain (pinprick) were examined on the residual and contralateral limbs of 16 veterans with TTA. Six subjects demonstrated normal sensation on the contralateral limb and impaired sensation of superficial pain, vibration, and/or light touch on the residual limb. Superficial pain was the most frequently impaired sensation, and vibration and superficial pain sensation appeared to be age-dependent, with increased impairment observed in the elderly. Deep pressure sensation was intact in all subjects. These preliminary data suggest that although neither the amputation nor the prosthetic rehabilitation resulted in impaired deep pressure sensation, these two factors contributed to minimal impairment of light touch and vibration, and significant impairment of the superficial pain sensation

The Veterans Health Administration’s Traumatic Brain Injury Screen and Evaluation: Practice Patterns

The goals of this study were to describe clinical practice patterns associated with the Veterans Health Administration’s (VHA’s) Comprehensive Traumatic Brain Injury Evaluation (CTBIE) and determine whether practice patterns vary by patient, provider, or facility characteristics. Veterans (N = 614) who had initial healthcare visits between 2008 and 2011 and who had previously completed the VHA’s traumatic brain injury (TBI) screen and subsequent CTBIE were drawn from a national database. Participants were primarily male (95%) with a mean age of 29.8 yr (standard deviation = 8). Chart reviews were conducted on a random sample of charts with completed CTBIEs from 21 sites. Using a cross-sectional design, patientand facility-specific variables were investigated as potential predictors of practice variation. During the study period, 79% of patients in this national sample were screened within 1 d of their initial healthcare visit and 65% were evaluated via CTBIE within 30 d of screening. Provider and participant characteristics were generally not associated with timeliness. The CTBIE was completed by individuals versus teams at comparable rates. Much of what occurred during the evaluation, beyond TBI-specific procedures, were medical assessments, such as review of medications and other substances