Return to work post spinal cord injury through a comprehensive rehabilitative program: A case series.

CONTEXT: Spinal cord injury (SCI) can impair bodily functions and limit an individual's ability to maintain or gain steady employment. Vocational rehabilitation programs have been shown to effectively facilitate individuals with a SCI to return to work, however, further research is needed on the implementation, outcomes, and feasibility of such programs including with the integration of healthcare. OBJECTIVE: The objective of this single-group study was to assess the effectiveness of a comprehensive vocational rehabilitation program, as measured by improvements in employment, work confidence, life satisfaction, and quality of life for individuals with a SCI. METHODS: Four individuals with a SCI participated in the vocational rehabilitation program. Participants were assigned responsibilities within their department of interest and attended weekly meetings with the vocational rehabilitation team to address barriers, discuss resources and education, and set professional goals. Completion of pre and post-test assessments was required to evaluate the program's impact on participants' work readiness and overall well-being. RESULTS: Each participant worked with an interdisciplinary team on an individualized work-plan (over 100 h of employment) with necessary accommodations for successful rehabilitation. Participants reported beneficial changes in multiple post-program assessment categories including physical, social, and emotional functions, with all reporting a general improvement in physical strength upon completion of the program. CONCLUSION: Our findings suggest that a comprehensive vocational rehabilitation program can be effective in facilitating individuals with SCI to gain greater functional independence and confidently pursue employment. Further studies are crucial to advance the knowledge required to implement a successful rehabilitative program.

Sleep Quality Should Be Assessed in Inpatient Rehabilitation Settings: A Preliminary Study.

OBJECTIVES: In this preliminary, longitudinal study, our objective was to assess changes in sleep quality during an inpatient stay in a rehabilitation setting in the United States and to relate changes to patients' demographic and clinical characteristics (i.e., age, gender, BMI, ethnicity, reason for hospitalization, pre-hospital living setting, prior diagnosis of sleep disorders, and mental health status). METHODS: A total of 35 patients participated in this preliminary study (age = 61 ± 16 years old, 50% <65; BMI = 30 ± 7 kg/m2; 51% female; 51% Caucasian). The average length of hospitalization was 18 ± 8 days. Reasons for hospitalization included orthopedic-related issues (28%), spinal cord injury (28%), stroke (20%), and other (23%). In this sample, 23% had prior sleep disorders (mostly sleep apnea), and 60% came from an acute care unit. Patients' sleep quality was assessed using the Pittsburgh sleep quality index (PSQI) at admission and before discharge. Demographic and medical data were collected. Patients' mental health status was also assessed at the same intervals. Nighttime sound levels and the average number of sleep disturbances were also collected throughout the study (6 months). RESULTS: Our data revealed that most patients had poor sleep (PSQI > 5) at admission (86%) and discharge (80%). Using a repeated ANOVA, a significant interaction was obtained between sleep quality and the presence of a diagnosed sleep disorder [F (1, 33) = 12.861, p = 0.001, η2p = 0.280]. The sleep quality of patients with sleep disorders improved over their stay, while the sleep of patients without such disorders did not. The mean nighttime sound collection level averages and peaks were 62.3 ± 5.1 dB and 86.1 ± 4.9 dB, respectively, and the average number of sleep disturbances was 2.6 ± 1.1. CONCLUSION: The improved sleep observed in patients with vs. without sleep disorders might be related to the care received for treating such disorders over the stay. Our findings call for the better detection and management of poor sleep in acute inpatient rehabilitation settings. Furthermore, if our findings are replicated in the future, studies on the implementation of quiet times for medical staff, patients, and family should be performed to improve sleep quality in the inpatient rehabilitation setting.

Evaluating the Sensoria Smart Socks Gait Monitoring System for Rehabilitation Outcomes.

BACKGROUND: Gait monitoring is important for rehabilitation but clinic-based measurements provide a brief snapshot of gait patterns. Many consumer-based activity monitors facilitate continuous gait monitoring in daily life but may be subject to measurement errors. This study examines a novel consumer-based activity monitor that is worn on the feet, and therefore not susceptible to inaccurately detecting upper body movements as gait. OBJECTIVE: To evaluate the clinical validity of Sensoria smart socks, a commercially available wireless gait monitoring technology. DESIGN: A method comparison study between the GAITRite, a criterion standard for clinical gait monitoring, and Sensoria smart socks. SETTING: Outpatient rehabilitation clinic. PARTICIPANTS: Thirty individuals capable of supervised ambulation, with or without assistive devices, were recruited through the use of flyers and emails. Data were analyzed for 29 participants. Fifteen participants had no neurologic diagnosis. Fourteen participants had a neurologic diagnosis that could result in gait impairments. Diagnoses included Parkinson disease, stroke, brain injury, developmental delay, and acoustic neuroma. METHODS: Participants completed three gait trials with simultaneous measurements by the smart socks and the GAITRite. MAIN OUTCOME MEASURES: Measurements of step count, cadence, and velocity were compared between the two gait monitoring systems. RESULTS: There was no significant difference in step count measurements between the two systems. Although there was a significant difference in cadence measurements for the total sample group, the mean difference fell within the GAITRite Standard Error of Measurement. There was no significant difference in velocity measurements for the total sample group and the mean difference fell within the GAITRite Standard Error of Measurement. CONCLUSION: These results support the clinical validity of the smart socks for measuring step number and velocity. Further investigation is warranted to determine the efficacy and clinical value of the smart socks system for measuring cadence and for monitoring gait over longer distances outside the clinic. LEVEL OF EVIDENCE: III.