Roxanna M. Bendixen

A Pilot Study Examining Activity Participation, Sensory Responsiveness, and Competence in Children with High Functioning Autism Spectrum Disorder.

This pilot study explored activity patterns in children with and without ASD and examined the role of sensory responsiveness in determining children’s level of competence in activity performance. Twenty-six children with high functioning ASD and twenty-six typically-developing children 6–12xa0years old were assessed using the Sensory Profile and the Child Behavior Checklist. Results reflect differences in the types of activities and jobs/chores engaged in by children with ASD compared to children without ASD. Significant differences were seen in overall level of competence in activities, social, and school performance. Children demonstrating more frequent Sensory Sensitivity and Sensory Avoiding had significantly lower competence scores than children with fewer behaviors in these domains, suggesting that sensory responsiveness may impact the ability to participate successfully.

Participation and quality of life in children with Duchenne muscular dystrophy using the International Classification of Functioning, Disability, and Health.

BackgroundDuchenne muscular dystrophy (DMD) is characterized by muscle damage and progressive loss of muscle function in male children. DMD is one of the most devastating genetically linked neuromuscular diseases for which there is currently no cure. Most clinical studies for DMD utilize a standard protocol for measurement exploring pathophysiology, muscle strength and timed tasks. However, we propose that examining broader components of health as emphasized by the International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY) may be of great value to children and their families, and important outcomes for future clinical trials.MethodsFifty boys with DMD and 25 unaffected age-matched boys completed two self-report measures: the Children’s Assessment of Participation and Enjoyment and the Pediatric Quality of Life InventoryTM 4.0. We investigated differences between the two groups with regard to participation in life activities and perceived quality of life (QoL). Additionally, we compared participation in activities and QoL in both cohorts of younger and older boys.ResultsParticipation in physical activities was significantly lower in boys with DMD than unaffected boys. Perceived QoL was markedly diminished in children with DMD relative to unaffected controls, except in the emotional domain. The amount of time boys engage in an activity, as well as participation in social activities, declined for our older boys with DMD but no changes were observed for our older unaffected boys. For both groups, QoL remained constant over time.ConclusionsThe ICF-CY provides a conceptual framework and specific terminology that facilitates investigation of the consequences of impairment in children and youth. Our study is one of the first to explore participation in a cohort of boys with DMD. It was not surprising that activities of choice for boys with DMD were less physical in nature than unaffected boys their age, but the consequences of less social engagement as the boys with DMD age is of great concern. Results from our study underscore the need to further evaluate activities that children elect to participate in, with special emphasis on facilitators and barriers to participation and how participation changes throughout the course of a disease.

Cost Effectiveness of a Telerehabilitation Program to Support Chronically Ill and Disabled Elders in Their Homes

Chronic illnesses account for approximately 75% of all healthcare costs in the United States today, resulting in functional limitations and loss of independence, as well as increased medical expenditures. The elderly population is at a higher risk for developing chronic conditions, increasing their risk for disabilities. Given the rapid growth of the aging population, and the chronic illnesses, disabilities, and loss of functional independence endemic to elders, novel methods of rehabilitation and care management are urgently needed. Telehealth models that combine care coordination with communications technology offer a means for managing chronic illnesses, thereby decreasing healthcare costs. We examined the effects of a Veterans Administration (VA) telerehabilitation program (Low Activities of Daily Living [ADL] Monitoring Program-LAMP) on healthcare costs. LAMP is based on a rehabilitative model of care. LAMP patients received adaptive equipment and environmental modifications, which focused on self-care and safety within the home. LAMP Care Coordinators remotely monitored their patients vital signs and provided education and self-management strategies for decreasing the effects of chronic illnesses and functional decline. The matched comparison group (MCG) received standard VA care. Healthcare costs 12 months preenrollment and 12 months post-enrollment were examined through a difference-in-differences multivariable model. Using actual costs totaled for these analyses, no significant differences were detected in post-enrollment costs between LAMP and the MCG. For LAMP patients, the provision of adaptive equipment and environmental modifications, plus intensive in-home monitoring of patients, led to increases in clinic visits post-intervention with decreases in hospital and nursing home stays.

Relationships of thigh muscle contractile and non-contractile tissue with function, strength, and age in boys with Duchenne muscular dystrophy

The purpose of this study was to assess the contractile and non-contractile content in thigh muscles of patients with Duchenne muscular dystrophy (DMD) and determine the relationship with functional abilities. Magnetic resonance images of the thigh were acquired in 28 boys with DMD and 10 unaffected boys. Muscle strength, timed functional tests, and the Brookes Lower Extremity scale were also assessed. Non-contractile content in the DMD group was significantly greater than in the control group for six muscles, including rectus femoris, biceps femoris-long head and adductor magnus. Non-contractile content in the total thigh musculature assessed by MRI correlated with the Brookes scale (r(s)=0.75) and supine-up test (r(s)=0.68), as well as other functional measures. An age-related specific torque increase was observed in the control group (r(s)=0.96), but not the DMD (r(s)=0.06). These findings demonstrate that MRI measures of contractile and non-contractile content can provide important information about disease progression in DMD.

The Impact of Roadway Intersection Design on Driving Performance of Young and Senior Adults

Objective. To test the effectiveness of the FHWA guidelines for intersection design. Methods. In an experimental design we used kinematics measures from an instrumented vehicle and behavioral (error) data collected during on-road evaluations to quantify the effects of improved versus unimproved intersections (turn phase) and to determine if these intersections were safer (vehicular stability and driver confidence) for both older (65–85 years) and younger (25 –45) drivers. We analyzed kinematics data with a 2 × 2 repeated measures ANOVA and behavioral data (driving errors yes, no) with Wilcoxon sign rank test (within subject variable: intersection improved vs. unimproved) and Wilcoxon rank sum test (between subject variable: age, younger vs. older driver). Results. Kinematics measures (turn phase), showed three maneuvers had statistically significantly lesser side forces (measured by lateral acceleration and combined acceleration) for the improved conditions, and four maneuvers had statistically significantly greater, yet appropriate, speeds for the improved conditions. Lesser side forces indicated improved lateral stability and increased speed indicated greater confidence. Drivers made fewer errors on two of the improved intersections; but across all maneuvers, older drivers appeared to make fewer errors on the improved intersections. Conclusions. This study brings empirical intersection design and safety information for engineers and city planners to consider as they plan and develop intersections. Future researchers may want to use the conceptual and analytical framework of this study to determine the effectiveness of other FHWA guidelines. Given that these intersection design guidelines benefit younger and older drivers alike, plausible policy-making opportunities are opened in the design of safe roadway systems, to benefit the broad spectrum of adult drivers.

The Impact of Intersection Design on Simulated Driving Performance of Young and Senior Adults

Purpose. The Federal Highway Administration (FHWA) proposed guidelines for highway design to increase the safe driving ability of older drivers; however, little empirical evidence exists to support the effectiveness of these guidelines. The purpose of this study was to investigate the effects of implementing these guidelines (in 4 pairs of intersections) on safe driving performance of older and younger drivers using a high-fidelity driving simulator. Design and Methods. We replicated four intersection pairs (improved versus unimproved) in a high-fidelity, virtual reality driving simulator. Simulator scenarios were created from actual road locations, replicating road geometrics and traffic control devices. The simulators controls were integrated with an actual vehicle to make the driving experience as realistic as possible. Kinematic measures were obtained from the simulator in conjunction with driving errors recorded by trained driving evaluators sitting in the cab of the car. Thirty-nine subjects, 19 younger and 20 older adults, participated in the study. Results. For the kinematic data we found greater lateral control, as indicated by significantly smaller maximum yaw during the turn phase, at all of the improved intersections when compared to the unimproved intersections. We found some significant age differences, but mostly in only one of the intersection-pairs. For the behavioral data, there were significant differences in driving errors between improved and unimproved intersections in two intersection-pairs; however, there were no significant differences in driving errors between the older and younger drivers. Implications. The findings suggest that both young and older drivers may benefit from roadways with safety features recommended by the FHWA guidelines as indicated by the increased lateral control of the vehicle when negotiating these intersections. These findings generate critical information for those involved in the design of roadway systems.

In-Home Training for Fathers of Children with Autism: A Follow up Study and Evaluation of Four Individual Training Components

Literature regarding fathers of children with autism remains sparse, and because mothers are the more common intervening parent, few training methods have focused on fathers. Thus, we sought to evaluate effects of in-home training directed at fathers and their ability to train mothers in the same manner in which they were trained. Fathers were taught four skills commonly associated with in-home training interventions for parents of children with autism: following the child’s lead, imitation with animation, commenting on the child, and expectant waiting. Father skills were evaluated twice a week for 12xa0weeks during videotaped in-home father–child play sessions. Analyses included visual inspection of graphed data and statistical analyses of father skill acquisition, mother skill acquisition, and child behaviors with both parents. A multivariate repeated measures analysis of 18 dyads revealed significant increases in frequencies of fathers’ imitation with animation, expectant waiting, and commenting on the child. Child initiating rates increased significantly as did frequencies of child non-speech vocalizations. Analysis of mothers revealed significant increases in frequencies of imitation with animation, expectant waiting, and following the child’s lead. Child behaviors had similar results for father and mother sessions. Findings are consistent with those from our first study indicating that fathers can effectively implement skills that promote father–child social interactions and that children respond positively to this approach.

The Impact of Roadway Intersection Design on Driving Performance of Young and Senior Adults: Preliminary Results

The Federal Highway Administration (FHWA) proposed highway design guidelines to increase safe driving ability of older drivers, but little empirical evidence exists to support these guidelines. Using kinematics measures from an instrumented vehicle and on-road evaluations, the authors examined the safety effects of improved versus unimproved intersections in older (65–85) and younger (25–45) drivers. Kinematics measures showed that 4 maneuvers had significantly poorer lateral stability for the unimproved conditions, and significantly greater speed for the improved conditions. Behavioral measures showed that drivers had significantly fewer errors for 2 improved left-turn maneuvers, and fewer total errors overall, with older drivers having a higher mean number of errors. These findings suggested that the FHWA guidelines for safe road conditions result in safer driving by older and younger adults.

The level of agreement between child self-reports and parent proxy-reports of health-related quality of life in boys with Duchenne muscular dystrophy.

Purpose To investigate the level of agreement between child self-reports and parent proxy-reports of the health-related quality of life (HRQoL) in boys with Duchenne muscular dystrophy (DMD) using both classical test theory (CTT) and Rasch analysis.Methods A total of 63 boys with DMD and their parents completed the pediatric quality of life inventory version 4.0 child self-report and parent proxy-report of HRQoL, respectively. The data were analyzed using both the CTT (scale-score level) and Rasch analysis (item-level).ResultsThe intraclass correlation coefficient (ICC, scale-score level) between children and parents showed good to moderate agreement, although parents consistently underestimated their child HRQoL. In Rasch analysis (item-level), 1 out of 8 items was significantly different between children and parents in the physical health scale. Also, 3 out of 15 items were significantly different between those two groups in the psychosocial health scale.ConclusionsBy applying both scale-score and item-level analyses, our study seeks to broaden the understanding of the discrepancy of the ratings between child self-reports and parent proxy-reports. The findings could provide further information about the decision-making process when selecting therapy and care programs.

Using Telerehabilitation to Support Elders With Chronic Illness in Their Homes

As the number of persons with disabilities increases because of factors such as aging combined with chronic illnesses, the challenge of providing rehabilitation also increases. Unfortunately, financial considerations have shortened length of stay in acute and subacute settings and reduced rehabilitation services. With earlier discharges, there is an increased need to deliver services to patients in their homes in an efficient and cost-effective manner. Telerehabilitation is an emerging practice that uses communications technology for the remote delivery of rehabilitative care. The Low ADL Monitoring Program is a telerehabilitation program designed to deliver rehabilitation services through the provision of home environmental interventions, together with communications technology and care coordination.