Alexander Libin

Using peer mentoring for people with spinal cord injury to enhance self-efficacy beliefs and prevent medical complications.

AIMS AND OBJECTIVES Individuals with spinal cord injury/disease are faced with a myriad of psychosocial adjustment challenges. This article describes the implementation of a peer-mentoring programme designed to support this adjustment process for people with SCI/disease and the programmes believed impact on self-efficacy and prevention of medical complications. BACKGROUND With shorter length of stay in acute inpatient rehabilitation after spinal cord injury/disease, peer mentor programmes are becoming an important component to assist with education and community re-integration. DESIGN Quasi-experimental non-controlled pretest/post-test. METHOD Patients with newly acquired spinal cord injury/disease participated in a one-year spinal cord injury peer-mentoring programme. Peer mentors met with their assigned participants regularly during inpatient care and on discharge to track medical complications and assist with adjusting to life after spinal cord injury/disease. RESULTS In all, of 37 mentees enrolled, 24 successfully completed the programme. Sixty-seven per cent showed improved self-efficacy score between the two time points. Medical complications and doctor visits all decreased significantly between 0-6 months and 7-12 months. Our findings indicate that the older an individual is, the lower the likelihood of having a urinary tract infection (p = 0.006). The programme was well received by all mentees who felt they could connect well with their peer mentor. CONCLUSION Peer mentoring in a rehabilitation setting enhances the understanding of challenges that patients and medical staff deal with on a day-to-day basis. Our findings suggest it is important to monitor and educate individuals with spinal cord injury/disease at the acute stage to improve medical outcomes. Caution is advised in the interpretation of these results as they were obtained in a small non-random sample using self-report data. RELEVANCE TO CLINICAL PRACTICE Peer mentors play an increasingly important role in nurse-delivered education in the spinal cord injury/disease population.

Intensive electrical stimulation attenuates femoral bone loss in acute spinal cord injury.

To determine whether intensive electrical stimulation (ES) can reduce femoral bone mineral density (BMD) loss in acute spinal cord injury (SCI).

Regenerating matrix-based therapy for chronic wound healing: a prospective within-subject pilot study.

The aim of this study was to determine whether a skin‐specific bioengineered regenerating agent (RGTA) heparan sulphate mimetic (CACIPLIQ20) improves chronic wound healing. The design of this article is a prospective within‐subject study. The setting was an urban hospital. Patients were 16 African‐American individuals (mean age 42 years) with 22 wounds (mean duration 2·5 years) because of either pressure, diabetic, vascular or burn wounds. Two participants each were lost to follow‐up or removed because of poor compliance, resulting in 18 wounds analysed. Sterile gauze was soaked with CACIPLIQ20 saline solution, placed on the wound for 5 min, then removed twice weekly for 4 weeks. Wounds were otherwise treated according to the standard of care. Twenty‐two percent of wounds fully healed during the treatment period. Wounds showed a 15·2–18·1% decrease in wound size as measured by the vision engineering research group (VERG) digital wound measurement system and total PUSH scores, respectively, at 4 weeks (P = 0·014 and P = 0·003). At 8 weeks there was an 18–26% reduction in wound size (P = 0·04) in the remaining patients. Wound‐related pain measured by the visual analogue pain scale and the wound pain scale declined 60% (P = 0·024) and 70% (P = 0·001), respectively. Patient and clinician satisfaction remained positive throughout the treatment period. It is concluded that treatment with CACIPLIQ20 significantly improved wound‐related pain and may facilitate wound healing. Patient and clinician satisfaction remained high throughout the trial.

New Diagnostic Tool for Robotic Psychology and Robotherapy Studies

Robotic psychology and robotherapy as a new research area employs a systematic approach in studying psycho-physiological, psychological, and social aspects of person-robot communication. An analysis of the mechanisms underlying different forms of computer-mediated behavior requires both an adequate methodology and research tools. In the proposed article we discuss the concept, basic principles, structure, and contents of the newly designed Person-Robot Complex Interactive Scale (PRCIS), proposed for the purpose of investigating psychological specifics and therapeutic potentials of multilevel person-robot interactions. Assuming that human-robot communication has symbolic meaning, each interactive pattern evaluated via the newly developed scale is assigned certain psychological value associated with the persons past life experiences, likes and dislikes, emotional, cognitive, and behavioral traits or states. PRCIS includes (1) assessment of a persons individual style of communication with the robotic creature based on direct observations; (2) the participants evaluation of his/her new experiences with an interactive robot and evaluation of its features, advantages and disadvantages, as well as past experiences with modern technology; and (3) the instructors overall evaluation of the session.

Barriers for individuals with spinal cord injury returning to the community: a preliminary classification.

BACKGROUND With decreased length of stay for inpatient rehabilitation, individuals with newly acquired spinal cord injury (SCI) might be discharged back into the community without the level of knowledge and functional skills necessary to live successfully post injury. This research studied the course of recovery and outcomes after the delivery of a coordinated inpatient rehabilitation system of care for individuals with SCI. OBJECTIVE Individuals with newly acquired SCI face numerous barriers during reintegration into the community. The purpose of this article is to identify and develop a preliminary classification of barriers to community reintegration that persons with SCI experience during the post-acute period. METHODS This 1-year study is the qualitative arm of a randomized controlled pilot study. Twenty-six people with SCI participated (mean age 40.6 years, 81% male and 54% tetraplegic). Self-reported data were collected during the first year post discharge from inpatient rehabilitation. RESULTS The three most common categories of self-reported barriers were mobility and equipment issues (23%), lack of environmental, and home assistance (20%), and insurance issues (18%). The two most common specific barriers were lack of insurance coverage (6.5% of all reported barriers) and residing in a nursing home (5.4%). CONCLUSION Our findings provide a preliminary classification of the barriers newly injured persons with SCI encounter during the post-acute period.

Beyond the evidence-based practice paradigm to achieve best practice in rehabilitation medicine: a clinical review.

Best practice is a practice that, on rigorous evaluation, demonstrates success, has had an impact, and can be replicated. It is differentiated from its constituent parts, evidence‐based practice and knowledge translation, by its general meaning and global purview. The purpose of this clinical review is to provide transparency to the concept and achievement of best practice in the context of rehabilitation medicine. The authors will review and analyze the roles of evidence‐based practice and knowledge translation in rehabilitation medicine as they work to support best practice. Challenge areas will be discussed, including an evidential hierarchy in need of update, a lack of “high‐level” research evidence, and delays in translating evidence to practice. Last, the authors will argue that rehabilitation medicine is well‐positioned to effect change by promoting inclusion of emerging research methodologies and analytic techniques that better capture context‐specific rehabilitation evidence, into the evidential hierarchy. Achieving best practice is dependent on this, as well as alignment of all key stakeholders, ranging from the patient, researchers and clinicians, to policymakers, payers, and others.

Executive functioning in TBI from rehabilitation to social reintegration: COMPASS goal, a randomized controlled trial (grant: 1I01RX000637-01A3 by the VA ORD RR&D, 2013–2016)

BackgroundTraumatic brain injury is a major health problem that frequently leads to deficits in executive function. Self-regulation processes, such as goal-setting, may become disordered after traumatic brain injury, particularly when the frontal regions of the brain and their connections are involved. Such impairments reduce injured veterans’ ability to return to work or school and to regain satisfactory personal lives. Understanding the neurologically disabling effects of brain injury on executive function is necessary for both the accurate diagnosis of impairment and the individual tailoring of rehabilitation processes to help returning service members recover independent function.Methods/designThe COMPASSgoal (Community Participation through Self-Efficacy Skills Development) program develops and tests a novel patient-centered intervention framework for community re-integration psychosocial research in veterans with mild traumatic brain injury. COMPASSgoal integrates the principles and best practices of goal self-management. Goal setting is a core skill in self-management training by which persons with chronic health conditions learn to improve their status and decrease symptom effects. Over a three-year period, COMPASSgoal will recruit 110 participants with residual executive dysfunction three months or more post-injury. Inclusion criteria combine both clinical diagnosis and standardized scores that are >1 SD from the normative score on the Frontal Systems Rating Scale. Participants are randomized into two groups: goal-management (intervention) and supported discharge (control). The intervention is administered in eight consecutive, weekly sessions. Assessments occur at enrollment, post-intervention/supported discharge, and three months post-treatment follow-up.DiscussionGoal management is part of the “natural language” of rehabilitation. However, collaborative goal-setting between clinicians/case managers and clients can be hindered by the cognitive deficits that follow brain injury. Re-training returning veterans with brain injury in goal management, with appropriate help and support, would essentially treat deficits in executive function. A structured approach to goal self-management may foster greater independence and self-efficacy, help veterans gain insight into goals that are realistic for them at a given time, and help clinicians and veterans to work more effectively as true collaborators.

Use of Platelet Rich Plasma for the Treatment of Bicipital Tendinopathy in Spinal Cord Injury: A Pilot Study

The purpose of study is to explore the efficacy and safety of platelet rich plasma (PRP) in the nonoperative management of shoulder tendinopathy amongst individuals with spinal cord injury. This objective was met by completing a pilot study on the effectiveness and safety of a PRP injection into the biceps tendon demonstrating clinical and ultrasonagraphic pathology. Recent analysis of the preliminary pilot data has demonstrated remarkably convincing results demonstrating both the safety and efficacy of this novel intervention.

Medical Educational Simulations: Exploring Reciprocity Between Learners’ Skills, Attitudes, and Career Intentions: A Case Study of Simulation Education Research

The purpose of this chapter is to present a case study of experiential learning in healthcare simulation through express assessment focused on measuring learners’ experiences with educational medical simulations (MedSims) with regard to three dimensions: functional skills, attitudes toward usefulness of MedSims in professional education, and career intentions. A learning-on-demand event called “Doctor for a Day Simulation Program (DOC)” attracted 510 high school students of both genders with age ranging from 14 to 18 years who were enrolled in a summer school at the National Student Leadership Conference. Learners interacted with at least four out of five types of medical simulation platforms over the period of over 4 h at the MedStar Health-affiliated Simulation and Training Environment Laboratory (SiTEL) in the metropolitan area of Washington, District of Columbia, USA. The learning experience was measured via newly developed express method based on Learning Experiences with Technology Scale (LETS) along with three domains: level of functional skills as they relate to digital technology and video gaming, attitudes toward the use of MedSims in educational training, and intentions to pursue a healthcare career. The findings demonstrate that there are no linear relationships between the individual level of functional skills and attitudes toward MedSims and that the learners with the low level of functional skills expressed positive attitudes toward MedSims in the same way as students who play video games on a daily basis and therefore have high level of skills. At the same time, positive evaluation of learning experiences with educational medical simulations was associated with expressed intentions toward healthcare career as a relevant professional choice.