Karen Kott

Comparison Between the C-leg® Microprocessor-Controlled Prosthetic Knee and Non-Microprocessor Control Prosthetic Knees: A Preliminary Study of Energy Expenditure, Obstacle Course Performance, and Quality of Life Survey

This study investigated energy expenditure and obstacle course negotiation between the C-leg® and various non-microprocessor control (NMC) prosthetic knees and compared a quality of life survey (SF-36v2™) of use of the C-leg® to national norms. Thirteen subjects with unilateral limb loss (12 with trans-femoral and one with a knee disarticulation amputation) participated in the study. The mean age was 46 years, range 30 – 75. Energy expenditure using both the NMC and C-leg® prostheses was measured at self-selected typical and fast walking paces on a motorized treadmill. Subjects were also asked to walk through a standardized walking obstacle course carrying a 4.5 kg (10 lb) basket and with hands free. Finally, the SF-36v2™ was completed for subjects while using the C-leg®. Statistically significant differences were found in oxygen consumption between prostheses at both typical and fast paces with the C-leg® showing decreased values. Use of the C-leg® resulted in a statistically significant decrease in the number of steps and time to complete the obstacle course. Scores on a quality of life index for subjects using the C-leg® were above the mean for norms for limitation in the use of an arm or leg, equal to the mean for the general United States population for the physical component score and were above this mean for the mental component score. Based on oxygen consumption and obstacle course findings, the C-leg® when compared to the NMC prostheses may provide increased functional mobility and ease of performance in the home and community environment. Questionnaire results suggest a minimal quality of life impairment when using a C-leg® for this cohort of individuals with amputation.

Standardized Walking Obstacle Course (SWOC): reliability and validity of a new functional measurement tool for children.

Purpose: This study reports reliability of the Standardized Walking Obstacle Course (SWOC) and concurrent validity with the Timed Up and Go (TUG) for use in children with and without developmental disabilities. Methods: Seventy-three children completed the SWOC and TUG during each of two sessions scheduled one week apart. Two raters took measures of time and number of steps on the SWOC to correlate with the same measures on the TUG. Results: Very high interrater reliabilities for time (intercorrelation coefficient [ICC] 0.99) and number of steps (ICC 0.94–0.99) noted. High intrarater reliabilities recorded for time (ICC 0.83–0.97) and number of steps (ICC 0.84–0.96). Significant correlations (p < 0.05) between the TUG and SWOC were moderate to very high for time (r = 0.72–0.90) and number of steps (r = 0.63–0.92). Conclusion: The SWOC demonstrates good reliability within and between raters and concurrent validity with the TUG for use with children to establish their functional ambulation capability. The SWOC could easily be used in any setting for any child who can follow the directions and walk without an assistive device. Further testing is needed of the use of the SWOC to detect change and measure the extent of the environments influence on activity and participation for different populations of children.

Effects of orthoses on upright functional skills of children and adolescents with cerebral palsy.

Purpose: Most research details the influence of orthoses on impairments in children with cerebral palsy. The purpose of this study was to determine the effect of orthoses on multiple tests of function. Methods: The researchers used the Standardized Walking Obstacle Course (SWOC), Pediatric Balance Scale (PBS), performance on individualized goals related upright function, and self‐reports of comfort and stability with and without orthoses to examine 28 children (5.4‐19.1 years of age) with cerebral palsy. Results: No significant differences were found in performance on the SWOC and PBS with and without orthoses. Only 18% of the children performed better on an individualized goal with their orthoses, but 48% of the children reported more feelings of comfort and stability while wearing orthoses. Conclusions: Results of this study bring into question the use of orthoses to improve functional balance and ambulation in children with cerebral palsy. (Pediatr Phys Ther 2002;14:199‐207) cerebral palsy/rehabilitation, child, gait, equilibrium, comparative study, orthotic devices.

Telehealth and eHealth in Nurse Practitioner Training: Current Perspectives

Telehealth is becoming a vital process for providing access to cost-effective quality care to patients at a distance. As such, it is important for nurse practitioners, often the primary providers for rural and disadvantaged populations, to develop the knowledge, skills, and attitudes needed to utilize telehealth technologies in practice. In reviewing the literature, very little information was found on programs that addressed nurse practitioner training in telehealth. This article provides an overview of both the topics and the techniques that have been utilized for training nurse practitioners and nurse practitioner students in the delivery of care utilizing telehealth. Specifically, this article focuses on topics including 1) defining telehealth, 2) telehealth etiquette, 3) interprofessional collaboration, 4) regulations, 5) reimbursement, 6) security/Health Insurance Portability and Accountability Act (HIPAA), 7) ethical practice in telehealth, and 8) satisfaction of patients and providers. A multimodal approach based on a review of the literature is presented for providing the training: 1) didactics, 2) simulations including standardized patient encounters, 3) practice immersions, and 4) telehealth projects. Studies found that training using the multimodal approach allowed the students to develop comfort, knowledge, and skills needed to embrace the utilization of telehealth in health care.

How to Prepare Interprofessional Teams in Two Weeks: An Innovative Education Program Nested in Telehealth

Abstract Problem: Preparing health professional students for interprofessional collaborative practice, especially at a distance where provider shortages prevail remains difficult. Approach: A two-week interprofessional education (IPE) immersion experience preparing students from 11 disciplines and four universities was implemented. Week-one, using online technology, students develop/present an interprofessional careplan for a complex patient. Students then meet face-to-face to conduct group interviews with two standardized patient dyads. Week-two, students develop a website for use of the patient dyads. Websites are presented to faculty and fellow students via an online virtual meeting space. Outcomes: To date, 594 students have participated demonstrating capacity to: 1.effectively engage in interprofessional care,  2. utilize Telehealth to impact care and break down barriers of isolation, and 3. implement skills to advance healthcare. Conclusion: IPE combined with Telehealth technology provides future providers with knowledge and skills for interprofessional care regardless of geographic barriers. Next Step: Integrate more technology using mobile devices and enhance the evaluation process.

Telehealth etiquette in home healthcare: the key to a successful visit.

The use of telehealth by home healthcare agencies is growing. It has been shown to reduce rehospitalizations by up to 62%, reduce costs, and increase efficiency. Due to the use of telehealth technology, new and unique rules of etiquette must be followed to make both the patient and clinician comfortable and satisfied with the process. Little literature exists regarding telehealth etiquette. This article explores the techniques and methods that home care clinicians should utilize to assure that the telehealth experience is positive and effective. After providing a less successful scenario, steps for success are outlined and a suggested successful conclusion is provided for the scenario. Home care agencies will benefit greatly from expanding their ability to visit patients in different ways. Simple steps need to be taken to assure successful visits that follow the rules for assuring patient comfort, autonomy, and protection.

Sleep problems in children: an overlooked factor in evaluating behavior.

Sleep disturbance is a problem for many children; however, it remains an underevaluated factor when assessing behavior. The purpose of the current article is to explore sleep problems in children, as well as the effects that disrupted sleep patterns have on child behavior. The authors recommend strategies to guide the assessment of sleep and improve childrens sleep quality.

Predictors of Standardized Walking Obstacle Course Outcome Measures in Children With and Without Developmental Disabilities

Purpose: This study was designed to determine which characteristics of children predict measures on the Standardized Walking Obstacle Course (SWOC). Methods: SWOC testing was performed under 3 conditions: (1) walk, (2) walk with a tray, and (3) walk wearing shaded glasses. Trials consisted of standing up, walking the course in 1 direction, and sitting down. Children (n = 440) completed 2 trials per condition. Trial measures included time, and numbers of steps, stumbles, and steps off the path. Relationships were evaluated using Chi-square analyses and significant predictors were determined by multiple logistic regression analyses. Sensitivity and specificity were calculated to determine the accuracy of disability as a predictor. Results: Age, weight, and disability were the strongest predictors (P < .05). Increased age and weight predicted shorter time and fewest steps. Disability predicts longer time and most steps. Conclusion: The SWOC is appropriate to screen children for disabilities in functional ambulation.