A systematic review of the effectiveness of pressure relieving cushions in reducing pressure injury.

This systematic review seeks to gather and analyze the evidence on wheelchair pressure relieving cushions, and report on the optimal materials and designs for reducing pressure injury risk. The following research question guides this study: Which wheelchair cushions best reduce pressure injury risk? PIs continue to impact the health and function of wheelchairs users with significant mobility impairments. Pressure relieving cushions are typically prescribed to provide pressure relief in the pre-wound, wound, and post-wound phases. Presently, no published reviews analyze all of the commonly available cushion materials. Most comparison studies typically address a specific population such as spinal cord injury, or only a few styles of cushion design/materials. Results suggest air-cell cushions provide optimal pressure relief and shear reduction. Furthermore, small sample single cohort studies suggest off-loading cushions provide superior pressure relief beyond that of air-celled cushions but require additional research for greater generalizability.

PDAs as cognitive aids for people with multiple sclerosis.

OBJECTIVE: Cognitive impairment is a common symptom for people with multiple sclerosis (MS). This study evaluated the effects of an occupational therapy training protocol using personal digital assistants (PDAs) as assistive technology for people with cognitive impairment related to MS. METHODS: Twenty participants were trained to use PDAs by an occupational therapist. Assessments of functional performance were taken at the start of an 8-week pretreatment period, at the beginning and end of training, and 8 weeks after the conclusion of training. RESULTS: Participants demonstrated the ability to learn how to use basic PDA functions and retain learning for at least 8 weeks. Functional performance increased significantly with PDA use, and this gain was maintained at 8-week follow-up. CONCLUSION: This study provides evidence of an association between an intervention providing training in the use of a PDA and improvements in the everyday function of people with cognitive impairment related to MS.

Guidelines for the pharmacologic treatment of neurobehavioral sequelae of traumatic brain injury.

There is currently a lack of evidence-based guidelines to guide the pharmacological treatment of neurobehavioral problems that commonly occur after traumatic brain injury (TBI). It was our objective to review the current literature on the pharmacological treatment of neurobehavioral problems after traumatic brain injury in three key areas: aggression, cognitive disorders, and affective disorders/anxiety/ psychosis. Three panels of leading researchers in the field of brain injury were formed to review the current literature on pharmacological treatment for TBI sequelae in the topic areas of affective/anxiety/ psychotic disorders, cognitive disorders, and aggression. A comprehensive Medline literature search was performed by each group to establish the groups of pertinent articles. Additional articles were obtained from bibliography searches of the primary articles. Group members then independently reviewed the articles and established a consensus rating. Despite reviewing a significant number of studies on drug treatment of neurobehavioral sequelae after TBI, the quality of evidence did not support any treatment standards and few guidelines due to a number of recurrent methodological problems. Guidelines were established for the use of methylphenidate in the treatment of deficits in attention and speed of information processing, as well as for the use of beta-blockers for the treatment of aggression following TBI. Options were recommended in the treatment of depression, bipolar disorder/mania, psychosis, aggression, general cognitive functions, and deficits in attention, speed of processing, and memory after TBI. The evidence-based guidelines and options established by this working group may help to guide the pharmacological treatment of the person experiencing neurobehavioral sequelae following TBI. There is a clear need for well-designed randomized controlled trials in the treatment of these common problems after TBI in order to establish definitive treatment standards for this patient population.

Reducing the need for personal supports among workers with autism using an iPod Touch as an assistive technology: delayed randomized control trial.

Personal digital assistants (PDAs) are versatile task organizers that hold promise as assistive technologies for people with cognitive-behavioral challenges. This delayed randomized controlled trial compared two groups of adult workers with autism spectrum disorder (ASD) to determine whether the use of an Apple iPod Touch PDA as a vocational support improves work performance and reduces personal support needs on the job. Baseline data were collected on 50 adults with ASD who were beginning a vocational placement supported by a job coach. Participants were randomized to receive training in the use of a PDA as a vocational aid upon starting their job or after working 12 weeks without PDA support. Workers who received PDA training at the beginning of their job placement required significantly less hours of job coaching support (p = 0.013) during their first 12 weeks on the job than those who had not yet received the intervention. Functional performance between the two groups was not significantly different. The significant difference in hours of job coaching support persisted during the subsequent 12 weeks, in which both groups used a PDA (p = 0.017).

Smart homes for people with neurological disability: state of the art.

Smart home technology can include environmental adaptations that allow remote control of home appliances, electronic communication, safety monitoring and automated task cueing, any of which may prove useful for people with neurological disability. This article outlines currently available smart home technologies, examines the burgeoning research in this area, discusses clinical and consumer resources and reviews ethical, funding and professional training considerations for smart home applications. I conclude that more outcomes-based research and collaboration among stakeholders is essential in order to establish guidance for designing, selecting and implementing individualized smart home solutions for those with neurological disability.

Community integration: current issues in cognitive and vocational rehabilitation for individuals with ABI.

In this article, we examine cognitive and vocational rehabilitation and the issues related to minority veterans with acquired brain injury (ABI). As more service members are returning from conflict, ways to help them repair their lives, not only physically but also socially and economically, are increasingly needed. The challenges of ABI are multifactorial; that is, the problems are not just cognitive or emotional but spill over into community living and vocational issues. Individuals from racial/ethnic minority backgrounds often face even more difficulties. Therefore, we review the nature of cognitive and vocational rehabilitation and suggest areas for additional research.

Personal digital assistants as cognitive aids for individuals with severe traumatic brain injury: a community-based trial.

OBJECTIVE: The purpose of this study was to examine the efficacy of personal digital assistants (PDAs) as cognitive aids in a sample of individuals with severe traumatic brain injury (TBI). METHOD: The group included 23 community-dwelling individuals at least 1 year post-severe TBI, who had difficulties in performing everyday tasks due to behavioural memory problems. Participants were trained by an occupational therapist to use PDAs as cognitive aids and assessed for occupational performance (using Canadian Occupational Performance Measure (COPM)) and participation in everyday life tasks (using Craig Handicap Assessment and Rating Technique-Revised (CHART)) before training and 8 weeks after training concluded. RESULTS: Statistically significant improvement was noted for self-ratings of occupational performance and satisfaction with occupational performance (COPM); significant improvement in a self-rating of participation was noted (CHART-R). CONCLUSION: A brief training intervention utilizing PDAs as cognitive aids is associated with improved self-ratings of performance in everyday life tasks among community-dwelling individuals with severe TBI.