Maureen Linden

Clinical skin temperature measurement to predict incipient pressure ulcers.

OBJECTIVE To evaluate temperature differences between areas of erythema and surrounding healthy tissue to determine whether clinical temperature measurement of sites at risk for pressure ulcer development could be used to indicate tissue damage. To validate the temperature portion of the National Pressure Ulcer Advisory Panels new Stage I pressure ulcer definition. DESIGN Repeated measures design. SETTING Acute rehabilitation hospital. SUBJECTS 65 outpatients and inpatients presenting with pressure-induced erythema at areas at risk for pressure ulcer development. The subjects were primarily non-ambulatory and exhibited a range of skin pigmentation and disabilities, including spinal injury, multiple sclerosis, and lower-limb amputations. MAIN RESULTS The temperature and appearance of 80 pairs of erythematic and control sites were documented. Sites were considered to have equal temperatures if the difference was within plus or minus 1.0 degree F. Fifteen percent (n = 12) of the erythematic sites were the same temperature as the surrounding tissue, 23% (n = 18) of the erythematic sites were cooler than the control sites, and 63% (n = 50) were warmer. CONCLUSION Both increased and decreased temperature differences can be used to indicate reactive hyperemia or a Stage I pressure ulcer, but a tissue integrity problem may still exist despite the absence of a temperature difference.

Characterizing reactive hyperemia via tissue reflectance spectroscopy in response to an ischemic load across gender, age, skin pigmentation and diabetes

PURPOSE Pressure ulcers represent a major secondary complication for amputees with diabetes and further complications may arise since ulcers are particularly hard to heal in this population. This study characterized the hyperemic response to a localized ischemic load in people with diabetes and amputation and compared it to that of subjects without diabetes or amputation. SUBJECTS Case-control study matching subjects by gender, age, skin pigmentation, and smoking status. METHODS Applying 150 mmHg to the patellar tendon for 10 minutes induced reactive hyperemia (RH). Tissue reflectance spectroscopy measured hemoglobin (HbO(2)) concentration in tissue before, during and after application of pressure. Refill time, Maximum HbO(2), Time@Max HbO(2), RH area and RH half-life characterized the RH response and were analyzed using ANOVA. All values up to a level of p <0.1 are presented. RESULTS Analysis included responses from 88 subjects. RH magnitude and temporal parameters varied across skin pigmentation; smokers showed a decreased RH magnitude; vasodilator users had greater RH temporal parameters; no evidence of differences were found across disease state or age. CONCLUSION Decreased RH response in smokers and subjects with dark skin might indicate a reduced ability to recover from ischemia. The lack of difference in RH response between subjects with and without diabetes was consistent with studies using other disability groups and corroborates the theory that RH is locally mediated.

Workplace accommodations and unmet needs specific to individuals who are deaf or hard of hearing.

Purpose: The purpose of this paper is to identify the workplace accommodations used by individuals who are deaf or hard of hearing, to report the perceived impact of the accommodations and to identify unmet needs with respect to workplace accommodations. Method: Individuals who are deaf or hard of hearing participated in an online survey. Respondents identified with one of four levels of functional hearing ability and selected from descriptions of workplace accommodations. Each selection was ranked according to perceived importance, satisfaction and frequency of use. Respondents also commented on unmet needs. Results: The most common accommodations were telephone aids (55%), co-worker helps (34%) and electronic communication (31%). Importance and frequency of use ranked high among most respondents (76% and 87%, respectively). However, perceived satisfaction ranked high among only 50% of respondents. The most common unmet needs were effective communication in groups and lack of co-worker support. Conclusions: Workplace accommodations are viewed as important and frequently used by individuals who are deaf or hard of hearing. However, satisfaction with the accommodations is marginal at best. Unmet needs remain in the areas of communication in meetings, support of co-workers and the development of a more universally accessible workplace environment. Implications for Rehabilitation Individuals who are deaf or hard of hearing consider their workplace accommodations to be important and frequently used. Satisfaction with workplace accommodations among individuals who are deaf or hard of hearing is relatively low, indicating room for improvement in the design and application of such accommodations. Unmet needs for individuals who are deaf or hard of hearing remain in the area of effective communication in meetings with multiple participants. Universal (or Inclusive) Design principles should be used to help reduce barriers in workplace environments and with respect to common-use tools in the workplace.

Multispectral image analysis of bruise age

The detection and aging of bruises is important within clinical and forensic environments. Traditionally, visual and photographic assessment of bruise color is used to determine age, but this substantially subjective technique has been shown to be inaccurate and unreliable. The purpose of this study was to develop a technique to spectrally-age bruises using a reflective multi-spectral imaging system that minimizes the filtering and hardware requirements while achieving acceptable accuracy. This approach will then be incorporated into a handheld, point-of-care technology that is clinically-viable and affordable. Sixteen bruises from elder residents of a long term care facility were imaged over time. A multi-spectral system collected images through eleven narrow band (~10 nm FWHM) filters having center wavelengths ranging between 370-970 nm corresponding to specific skin and blood chromophores. Normalized bruise reflectance (NBR)- defined as the ratio of optical reflectance coefficient of bruised skin over that of normal skin- was calculated for all bruises at all wavelengths. The smallest mean NBR, regardless of bruise age, was found at wavelength between 555 & 577nm suggesting that contrast in bruises are from the hemoglobin, and that they linger for a long duration. A contrast metric, based on the NBR at 460nm and 650nm, was found to be sensitive to age and requires further investigation. Overall, the study identified four key wavelengths that have promise to characterize bruise age. However, the high variability across the bruises imaged in this study complicates the development of a handheld detection system until additional data is available.

Teleworkers with disabilities: Characteristics and accommodation use

BACKGROUND The prevalence of telework among people with disabilities is not as great as the general population, despite the accommodative benefits of telework. OBJECTIVE This study of employment and accommodation use patterns of people with disabilities investigates relationships between functional abilities, work location and nature, and accommodation use. PARTICIPANTS Currently employed subjects with disabilities were recruited from client lists of research, technical assistance, and service provision centers, as well as through over 100 social networking venues focused on individuals with disabilities. METHODS A national, cross-sectional survey was administered electronically. Details of accommodation use for 373 individuals were compared using Chi-Square distribution analysis. RESULTS Those in white-collar and knowledge-based jobs were twice as likely to telework as other worker types, and teleworkers were twice as likely to use flexible scheduling. Only 47% of teleworkers reported telework as a job accommodation. Of those, 57% were satisfied with telework and 76% reported it as important to job task completion. CONCLUSIONS Increased use of flexible scheduling, particularly among those who view telework as an accommodation, suggests the primary accommodative benefit of telework is to reduce pain and fatigue-related barriers to traditional employment. Relatively low satisfaction with telework suggests that it presents other employment-related barriers.

Telework rationale and implementation for people with disabilities: Considerations for employer policymaking

BACKGROUND Telework has been promoted as a viable workplace accommodation for people with disabilities since the 1990s, when information and communication technologies (ICT) had developed sufficiently to facilitate its widespread adoption. This initial research and accompanying policy recommendations were prescriptive in nature and frequently aimed at employers. OBJECTIVE This article adds to existing policy models for facilitating successful telework outcomes for people with disabilities. Drawing upon two studies by the Rehabilitation Engineering Research Center on Workplace Accommodations, we expound on employee-side considerations in the implementation of telework. METHODS Our policy model utilizes established typologies for policy evaluation to develop a process model that considers rationales and implementation factors for telework among people with physical disabilities. RESULTS Telework may be used as an accommodation for disability, but employee rationales for telework are more complex, involving work-life balance, strategies for pain and fatigue not formally recognized as disability, and expediency in travel and transportation. Implementation of telework as a component of workplace operations is similarly multifaceted, involving non-technology accommodations to realize job restructuring left incomplete by telework. CONCLUSIONS Our model grounds new empirical research in this area. We also renew our call for additional research on effective telework practices for people with disabilities.

Telework research and practice: Impacts on people with disabilities

Advances in Information Communication Technologies (ICTs), particularly in the mobility of computing power and virtual private networking (VPN) capabilities, have provided unprecedented flexibility regarding how and where work is performed. Employees, particularly those in knowledge-based jobs, are no longer tethered to a specific location to complete work. While technological advances provide the capacity for work from remote locations, the motivations for doing so are broad, encompassing legislated environmental considerations and perceived benefits to the employer and employee alike. The 1990 Amendments to the Clean Air Act mandated a 25% reduction in employee commutes for large organizations, and similar trip reductions for major cities [1]. The Clean Air Act did not specifically mandate telework as a required form of trip reduction; however, its role in reducing traffic and air pollution was explicitly detailed in the National Telecommuting and Air Quality Act [2]. Among the employer benefits for telework are the ability to recruit and retain talented employees, increase productivity, and reduce operation and real estate expenses [3,4], while employee benefits include increased productivity, job satisfaction, and flexibility [5–8]. Telework has been defined as the “practice of substituting communications and/or computer technology for actual travel to work or a central office” [9]. This definition encompasses a broad range of work practices, including: those who work solely from home [9–15], those who work from home to supplement other work modes [9–15], home-based or self-employment [9,12,14], flexible workplaces [9,11], work from community-based telework centers [9–11, 13,15], and work conducted while traveling [9–11]. While all of these work modes are considered to be telework, there are inherent differences between them and relative advantages to each of them, particularly to individuals with disabilities. Telework has the potential to facilitate employment for people with disabilities by removing barriers presented in traditional work environments and replacing the need to be physically at a specific location with ICT [9]. This exchange removes architectural and transportation barriers for those with physical, sensory, and cognitive limitations by allowing them to work in their home environment which, ideally, has been optimized to their functional abilities [10,11,15]. Additionally, telework allows employees to control their own schedules, thereby accommodating fatigue, stamina, and pain-related barriers to traditional fulltime work [10,15,16]. It allows access to medicallyrelated personal care services during the workday [15, 16]. In many cases, these services are only covered by insurance if they are provided in the home. Finally, it is thought that telework may benefit employees with disabilities by reducing disability-related bias and discrimination [10].

Barriers to Employment Participation of Individuals With Disabilities: Addressing the Impact of Employer (Mis)Perception and Policy:

Although progress has been made toward the objective of increased employment for people with disabilities, the 17.2% employment rate of people with disabilities stands in distressing contrast to the 65% rate of those without disabilities. This article summarizes the results of a comparative survey of representative academic literature and industry publications related to employer policies and practices that can affect workforce participation of individuals with disabilities. Emergent themes include variance in employer perspectives on hiring of individuals with disabilities, impact of perceived versus actual cost as a hiring barrier, and the perceived mismatch of education and/or skills to job qualifications among applicants with disabilities. These themes represent key areas to probe in subsequent research. The research objective is to identify focal points in the industry literature, representative of employer and industry (demand side) points of view that differ from those generally portrayed in the academic literature (more generally, supply side). Findings from a thematic analysis of industry publications can provide (1) evidenced based background to assist in crafting targeted policy to address employer awareness, (2) informed development of industry guidance on topics that may assist employers to achieve a more inclusive workplace, and (3) insights applicable to addressing barriers to broadening participation by technical, scientific, and engineering trained individuals with disabilities.