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Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/21742
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Browsing Other by Author "Bugnariu, Nicoleta"
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Item Quality of Life Assessment in Transtibial Amputees using K2 vs K3 Prosthetic Feet(2015-03) Kelly, Shayne R.; Bugnariu, Nicoleta; Patterson, Rita; Stevens, GordonThe functional level of transtibial amputees is used to determine the K-level classification of prosthetic feet that can be reimbursed. A lower K-level prosthesis lacks the technology of higher K-level prosthesis and thus may diminish the patient’s ability to perform daily tasks such as balance and gait while increases chances of expensive injuries due to trips and falls. Our hypothesis is that a K3 prosthesis will not only show improvements in daily tasks such as balance and gait but will also improve the patient’s quality of life. Ten subjects with transtibial amputations secondary to diabetes and vascular disease were recruited. Subjects were asked to participate in two visits. A V-gait CAREN (Computer Assisted Rehabilitation Environment Network, Motek Medical, The Netherlands) system and a 12-camera Motional Analysis System were used to create virtual environments where subjects were assessed performing balance and gait task. These two visits were separated by a two week trial period in which subjects were randomized to wear a K2 or K3 prosthetic foot above, below or at their specific level of function. Data collected at both visits were evaluated alongside quality of life information gathered from the Physiological Cost Index, the Reintegration to Normal Living Index, and the SF-36 questionnaires. Results were analyzed with pared t-tests. Subjects switching from a K2 to K3 level prosthesis showed a significant increase in SF 36 scores (p=0.0005). Those switching from a K3 to K2 level prosthesis expressed significant decrease in SF 36 scores (p=0.01). The quality of life domains most impacted in subjects switching from a K2 to K3 level were physical functioning, limitations due to physical health, as well as energy and fatigue. The only domain that was not impacted was social functioning. Subjects switching from a K3 to K2 level prosthetic expressed the greatest difference in limitations due to physical health, energy and fatigue, physical functioning and pain. The results to this point confirm that K3 prosthetic feet lead to a greater quality of life. Providing higher functioning prosthetics to lower functional level amputees may not only lead to improved balance and coordination, but it may also lead to increased cost effectiveness due to an elevated level of function with less injuries and falls. Therefore, it is vital that the proper prosthetic is prescribed to transtibial amputees.Item Reducing falls in post-acute Medicaid patients enrolled in the Safe Transitions for the Elderly Patient (STEP) Program(2015-03) Johnson, Valerie W.; Camp, Kathlene E.; Lardner, Dana; Bugnariu, Nicoleta; Knebl, JanicePurpose: The STEP Program is a hybrid transitional care model composed of interdisciplinary team members focused on reducing hospital readmissions, decreasing falls, and improving quality of life. Thus far, no transitional care program has been able to show a significant reduction in falls among post-acute, community dwelling older adults. As the first physical therapy (PT) team to be included in a transitional care program, we sought out to identify potential fallers and reduce falls in this vulnerable population. The purpose of this paper is to evaluate the contribution of PT intervention in the STEP program, specifically as it relates to decreasing falls and falls risk. Methods: We utilized a qualitative, subjective report instrument known as the 4-point Hopkins Falls Grading Scale (HFGS) with good face and content validity to discriminate between the severity and frequency of falls. A systematic, subjective history of falls and comprehensive fall risk assessment scores pre- and post- PT intervention were obtained and analyzed. All data was analyzed using SPSS, and according to the Shapiro-Wilk test, none of the fall data was normally distributed (all yielding p-values of .000). Therefore, we used the Wilcoxon Signed Rank Test to analyze the difference in medians for pre-STEP fall data at 3 months and post-STEP fall data. Results: Preliminary data of a subset of patients reveals promising results for the Hopkin’s Falls Grading Scale with 3 out of 4 grades showing a significant reduction in falls. The Wilcoxon Signed-Rank Test provided the following results. There was a significant decrease in number of Grade 4 Falls (p = .000). There was not enough evidence to support a significant difference in number of Grade 3 Falls (p = .065). There was a significant decrease in number of Grade 2 Falls (p = .000). Finally, there was a significant decrease in number of Grade 1 Falls (p = .004). Grade 3 falls showed no significant difference; however in our distribution, we only had 8 patients that reported Grade 3 falls, compared to 20 patients for Grade 4 falls, 22 patients for Grade 2 falls, and 19 patients for Grade 1 falls. Conclusions: These results confirm the need and importance of collecting pre- and post- PT intervention falls data. At this point in time, 3 out of 4 grades show a significant decrease in falls. The data suggests that transitional physical therapy is effective in showing a reduction in falls in older Medicaid patients recently discharged from the hospital.Item Role of Physical Therapy in the Interdisciplinary Team for Safe Transitions for Elderly Persons (STEP)(2015-03) Camp, Kathlene E.; Johnson, Valerie; Bugnariu, Nicoleta; Lardner, Dana; Knebl, JaniceBackground: Managing an effective transition from hospital to home is challenging due to the medical complexity of multiple diagnoses and care needs, especially in low income seniors. Early hospital readmission has been linked with many factors, including impaired mobility and ineffective management of diseases. Physical therapy (PT) can have an impactful role on addressing safety with mobility and supporting education on disease management. Purpose: The purpose of this report is to describe the role of PT on an interdisciplinary care team, describe the PT intervention, highlight fall risk assessments and results, and identify leading environmental hazards and supports that can impact fall risk. Methods: The STEP care team was comprised of a medical director, nurse practitioner or physician assistant, social worker, physical therapist, pharmacist and registered dietician. PT performed a comprehensive evaluation, appropriate fall risk assessment, and home safety evaluation. Recommendations and assistance were provided to improve home safety, education and intervention were implemented to address specific needs to improve safety with mobility, care was coordinated with home health resources, and community resources were utilized to access additional needs not met by insurer coverage. Final assessments were made at time period of 30+ days in accordance with successful transition in medical care. Results: 126 out of 161 patients enrolled into the STEP program received PT. Patients were in the STEP program for an average of 42 days and received an average of 3 PT visits. The most prevalent home safety hazards identified were lack of grab bars (45%), lack of supportive equipment for shower/tub (42%), unsafe bathroom tub/shower surfaces (30%), narrow/cluttered pathways (33%), and cluttered/soiled living areas (30%). The most common supports were adequate lighting (39%), appropriate commode height (58%), stable/supportive seating (40%), clear/accessible walkways (44%), and secure floor coverings (38%). Home modification opportunities were greatest for adjustment of commode and seating heights (79%, & 2%), providing adequate lighting and chair dressing support (60%), securing floor coverings (50%), and installing night lights (50%). For ambulatory clients, fall risk assessments indicated 96% were at risk for falls. There was an average of 9% of hospitalizations in the first 30 days; however none were related to falls. Conclusion: Reasons for falls are multifactorial and require an interdisciplinary approach to have effective reduction in risk. PT has a significant role in this reduction by addressing both the physical impairments and the environmental factors. Interprofessional collaboration on patient performance in the home can be instrumental in avoiding falls and preventing early hospital readmissions for this high risk population.Item The Effects of Hearing Loss on Balance in Older Adults: A Systematic Review(2015-03) Kowalewski, Victoria; Bugnariu, NicoletaPurpose:Falls due to poor postural control are a common problem within the older adult population, leading to many negative outcomes such as fractures, hospitalization, and even death. Traditionally, three sensory inputs – visual, vestibular, and somatosensory – are associated with the control of balance and have been investigated for their potential contribution to increased risk of falls. However, recent epidemiological research has brought attention to the notion that other sensory impairments, such as hearing loss, may affect balance. The purpose of this review is to systematically document the recent evidence linking hearing loss to balance impairments and increased risk for falls in seniors, and to present various hypotheses regarding the mechanisms by which auditory impairments may affect balance. Methods:A literature search was performed using the key terms: hearing loss, auditory impairment, older adults, elderly, balance, falls, hearing aids, hearing devices, gait, locomotion, cognition, and postural control. The databases PubMed, Scopus, CINAHL, Cochrane, ScienceDirect, and Medline were queried for articles published between January 2000 and June 2014. An initial screen was performed based on titles and abstracts. A total of 346 articles were found. A second reviewer who is an expert in the field screened the articles based on the relevance to the topic and narrowed the inclusion number to 72 articles. Literature reviews and articles about pediatrics were excluded from this review, which further narrowed the inclusion number to 47 articles. Results:The evidence from the literature supports a link between hearing loss and balance deficits. Four main theories exist that may explain why and how hearing loss may affect an older adult’s balance: (1) The Physiological Theory; (2) The Social Theory; (3) The Perceptual Theory; (4) The Cognitive Theory. The evidence strongly supports The Cognitive Theory; substantial evidence supports the Social Theory; not enough evidence is currently available in the literature to support or refute the Perceptual Theory and the Physiological Theory. Conclusions:The consequence of hearing loss on a person’s ability to maintain balance has not gained attention until recently and minimal research on the effects of hearing loss on balance exists. This report informs healthcare professionals about potential consequences of hearing loss on an individual’s postural control and the need for further research to be performed.Item The use of virtual reality and a sub-threshold vibratory noise as a tool to enhance sensory reintegration and postural control among patients with diabetic peripheral neuropathy.(2015-03) Pair, Brad; Bugnariu, NicoletaPurpose: Peripheral neuropathy frequently occurs among patients with diabetes and can result in many complications, including plantar sensory loss. Diminished sensation alters the sensory weighting mechanism, causing individuals to become increasingly reliant on visual stimuli to maintain adequate balance and postural control. The purpose of this study was to evaluate the clinical usefulness of a virtual reality- (VR) based sensory reweighting and balance training program that incorporates principles of the stochastic resonance theory in subjects with diabetic peripheral neuropathy. Methods: Seven subjects, ages 63 to 69 years old, with peripheral neuropathy due to type II diabetes have completed the study; enrollment is ongoing. This study was conducted using a V-Gait CAREN system. Subjects were fitted with vibratory devices placed around both ankles and underwent increasingly challenging postural stability activities over the course of 6 one-hour sessions. Visual dependency was reduced by manipulating the lighting conditions and applying visual distractions from the VR. Subjects received an acute application of a sub-threshold vibration throughout the duration of each session. Pre- and post- measurements of fall risk and standing balance were assessed at visits 1 and 8 using the Activity Balance Confidence (ABC), Falls Efficacy, and Clinical Test of Sensory Interaction for Balance (CTSIB). Data was analyzed using paired t-tests. Results: Post training analysis showed a significant improvement in ABC score (p=0.02) but not with Fall Efficacy score (p Conclusions: Subjects improved overall balance and sensory selection strategy as indicated by an improved ability to control both the amplitude and velocity of their sway during conditions of altered visual and somatosensory information. Preliminary results support the use of a sub-threshold background noise as an adjunct to a VR- based balance and sensory re-integration training program for individuals at risk for falls due to diabetic peripheral neuropathy.