Barriers and Translational Solutions to Improving Community Living Outcomes among People of Color with Disabilities with Opioid Use Disorder: A Focus Group Perspective.

This investigation examined vocational rehabilitation, substance abuse, and mental health service providers' perceptions about barriers and potentially translational solutions to poor community living outcomes for people of color with disabilities (i.e., African Americans, Latinx, Native Americans and Alaskan Natives, Asian Americans, and Pacific islanders) who have opioid use disorder. We conducted one focus group discussion (N = 12) that identified the proliferation of opioids in the community, treatment access, employment, and transportation as community living outcome barriers. The findings point to the need for further research that address poor outcomes among target group members.

Exploring Race Differences in Satisfaction With Rehabilitation Following Total Knee Arthroplasty: A Qualitative Study.

BACKGROUND: The purpose of this qualitative focus group study was to explore race differences in the rehabilitation experience and satisfaction with rehabilitation following total knee arthroplasty (TKA). METHOD: We conducted a series of qualitative focus group discussions with groups of non-Hispanic White and non-Hispanic Black older adults who recently underwent TKA. We used grounded theory approach, which asks the researcher to develop theory from the data that are collected. Participants discussed barriers and facilitators to accessing rehabilitation after surgery, opinions regarding their physical therapists, the amount of postoperative physical therapy received, and overall satisfaction with the postoperative rehabilitation process. RESULTS: Thirty-six individuals participated in focus groups. Three major themes emerged: (i) Participants reported overall positive views of their post-TKA rehabilitation experience. They particularly enjoyed one-on-one care, the ability to participate in "prehabilitation," and often mentioned specific interventions they felt were most helpful in their recovery. (ii) Despite this, substantial barriers to accessing physical therapy exist. These include suboptimal pain management, copayments and other out-of-pocket costs, and transportation to visits. (iii) There were minor differences in the rehabilitation experiences between Black and White participants. Black participants reported longer paths toward surgery and occasional difficulty interacting with rehabilitation providers. CONCLUSIONS: Individuals undergoing TKA can largely expect positive rehabilitation experiences postoperatively. However, some barriers to postoperative physical therapy exist and may differ between Black and White patients. Physical therapists should increase their awareness of these barriers and work to minimize them whenever possible.

Race Differences in Postacute Physical Therapy Utilization and Patient-Reported Function After Total Knee Arthroplasty.

OBJECTIVE: This observational cohort study included patients of Black and White race and non-Hispanic ethnicity with end-stage knee osteoarthritis who were scheduled to receive total knee arthroplasty (TKA) surgery. Our objective was to examine whether race differences exist in the use of physical therapy (PT) across all postacute settings and to examine patient-reported physical function following TKA. METHODS: We collected pre- and postoperative physical function data and postoperative rehabilitation data on 104 Black and White individuals undergoing TKA. Regression analyses and independent samples t-tests were used to explore the predictive value of race on postoperative functional outcome and to compare PT utilization within each postacute setting and across all postacute rehabilitation settings. RESULTS: Total PT received was similar between White and Black participants, but significant race differences in PT utilization existed within specific settings. Race did not significantly predict function after TKA, but Black participants had slightly lower self-reported function both before and after surgery than White participants. CONCLUSION: This is the first study to examine both PT utilization and functional outcomes in a sample of individuals undergoing TKA, and results indicate differences in where postoperative PT is received between Black and White patients.

Factors in Utilization of Telehealth Treatment by Rural African-Americans with Opioid Use Disorder and Disabilities.

This study explored factors that impact telehealth service utilization for treatment of African Americans with disabilities with opioid use disorder in rural communities. A focus group was conducted involving 12 different mental health, substance use, and rehabilitation counseling professionals. The analysis was completed using NVivo (Version 12). The results identified critical barriers that included historical distrust of technology and healthcare systems, digital divide/unavailability of Internet modems, fear of losing confidentiality, and agency non-approval. The benefits were improved communication, reduction of stigma, continuity of care, and convenience of collaboration. The findings indicate the need for additional research in this topic area.

Assistive Technology Workplace Accommodation and Employment among Diverse Populations with Disabilities: Does Race/Ethnicity Matter?

The purpose of this study was to examine the relationship between assistive technology workplace accommodation (AT-WA) usage and employment status among racial/ethnic populations with disabilities. Chi-square tests and logistic regression were used to analyze secondary data from the 2015 Kessler Foundation National Employment and Disability Survey (KFNEDS). Results indicated that significantly more consumers who used AT-WA were currently working, and a significantly greater proportion of them were White. Moreover, a significantly lower proportion of those who did not use AT-WA had less expected odds of being currently employed. Specific implications are discussed to inform practices, policy, and/or future research.

Community Living Outcome Factors for People of Color with Disabilities and Concomitant Opioid Use Disorder: A Scoping Review.

This scoping review mapped the pertinent extant published and grey literature and policy to assess factors that promote positive community living outcomes among people of color with disabilities and concomitant opioid use disorder (OUD) in the United States (U.S.). Forty-three publications covering OUD and people of color with disabilities and people of color with disabilities and community living content were reviewed. Select community living barriers and potential interventions were identified for people of color with disabilities in general; however, the review failed to classify such factors for those with OUD. Authors offered recommendations for practice, research, and policy.

Bartonella henselae Bloodstream Infection in a Boy With Pediatric Acute-Onset Neuropsychiatric Syndrome.

BACKGROUND: With the advent of more sensitive culture and molecular diagnostic testing modalities, Bartonella spp. infections have been documented in blood and/or cerebrospinal fluid specimens from patients with diverse neurological symptoms. Pediatric acute-onset neuropsychiatric syndrome (PANS) is characterized by an unusually abrupt onset of cognitive, behavioral, or neurological symptoms. Between October 2015 and January 2017, a 14-year-old boy underwent evaluation by multiple specialists for sudden-onset psychotic behavior (hallucinations, delusions, suicidal and homicidal ideation). METHODS: In March 2017, Bartonella spp. serology (indirect fluorescent antibody assays) and polymerase chain reaction (PCR) amplification, DNA sequencing, and Bartonella enrichment blood culture were used on a research basis to assess Bartonella spp. exposure and bloodstream infection, respectively. PCR assays targeting other vector-borne infections were performed to assess potential co-infections. RESULTS: For 18 months, the boy remained psychotic despite 4 hospitalizations, therapeutic trials involving multiple psychiatric medication combinations, and immunosuppressive treatment for autoimmune encephalitis. Neurobartonellosis was diagnosed after cutaneous lesions developed. Subsequently, despite nearly 2 consecutive months of doxycycline administration, Bartonella henselae DNA was PCR amplified and sequenced from the patient's blood, and from Bartonella alphaproteobacteria growth medium enrichment blood cultures. B henselae serology was negative. During treatment with combination antimicrobial chemotherapy, he experienced a gradual progressive decrease in neuropsychiatric symptoms, cessation of psychiatric drugs, resolution of Bartonella-associated cutaneous lesions, and a return to all pre-illness activities. CONCLUSIONS: This case report suggests that B henselae bloodstream infection may contribute to progressive, recalcitrant neuropsychiatric symptoms consistent with PANS in a subset of patients.

Why Public Health Researchers Should Consider Using Disability Data from the American Community Survey.

The United States (US) federal government allocates hundreds of billions of dollars to provide resources to Americans with disabilities, older adults, and the poor. The American Community Survey (ACS) influences the distribution of those resources. The specific aim of the project is to introduce health researchers to Public Use Microdata Sample file from 2009 to 2011. The overall goal of our paper is to promote the use of ACS data relevant to disability status. This study provides prevalence estimates of three disability related items for the population at or over the age of 15 years who reside in one of the continental states. When population weights are applied to the 7,198,221 individuals in the sample under analysis, they are said to represent 239,641,088 of their counterparts in the US population. Detailed tabulations by state (provided as Microsoft Excel® spreadsheets in ACS output) clearly show disability prevalence varies from state-to-state. Because analyses of the ACS data have the ability to influence resources aiding individuals with physical mobility challenges, its use should be promoted. Particular attention should be given to monetary allocations which will improve accessibility of the existing built environment for the individuals with mobility impairment.

Development of the Telehealth Usability Questionnaire (TUQ).

Current telehealth usability questionnaires are designed primarily for older technologies, where telehealth interaction is conducted over dedicated videoconferencing applications. However, telehealth services are increasingly conducted over computer-based systems that rely on commercial software and a user supplied computer interface. Therefore, a usability questionnaire that addresses the changes in telehealth service delivery and technology is needed. The Telehealth Usability Questionnaire (TUQ) was developed to evaluate the usability of telehealth implementation and services. This paper addresses: (1) the need for a new measure of telehealth usability, (2) the development of the TUQ, (3) intended uses for the TUQ, and (4) the reliability of the TUQ. Analyses indicate that the TUQ is a solid, robust, and versatile measure that can be used to measure the quality of the computer-based user interface and the quality of the telehealth interaction and services.

Training in Informatics: Teaching Informatics in Surgical Pathology.

This article presents an overview of the curriculum deemed essential for trainees in pathology, with mapping to the Milestones competency statements. The means by which these competencies desired for pathology graduates, and ultimately practitioners, can best be achieved is discussed. The value of case (problem)-based learning in this realm, in particular the kind of integrative experience associated with hands-on projects, to both cement knowledge gained in the lecture hall or online and to expand competency is emphasized.

Assistive technology use by disability type and race: exploration of a population-based health survey.

PURPOSE: To examine the relationships among Assistive Technology (AT) use, race, type of disability and selected other demographic characteristics. METHOD: Using 2009 National Health Interview Survey, descriptive statistics, statistical interactions and binary logistic regression were performed to identify, contrast and predict the likelihood of using AT based on the type of disability among African Americans (AAs) and European Americans (EAs). RESULTS: We found that more AAs (10% within group proportion of total AAs) used AT compared to EAs (7.5% within group proportion of total EAs). Physical (p < 0.001), auditory (p = 0.028) and emotional (p = 0.008) impairments were statistically significant predictors of AT use. However, physical impairment as a predictor of AT use was greater among AAs (OR = 222.49, CI: 64.04-773.04, p < 0.001) than EAs (OR = 50.77, CI: 31.78-81.12, p < 0.001). EAs had a greater number of disabling conditions that predict the use of AT than AAs, whereas AAs had more demographic characteristics beyond race that predict AT use than EAs. CONCLUSIONS: Disparities were observed in AT usage by disability types and demographic characteristics between AAs and EAs. Moreover, the predictive strength of AT usage based on disability types and other demographic variables differed by races. Overall, the findings about the different relationships among race, disability type, and AT use are found. Implications for Rehabilitation The finding may inform the development of initiatives by rehabilitation leaders to encourage the use of AT by AAs and EAs according to their type of impairment. Having identified physical impairment as statistically significant predictor of AT use greater among AAs, rehabilitation leaders should ensure that people living with those types of disability have access to the corresponding type of AT and can use them effectively.

Training in Informatics: Teaching Informatics in Surgical Pathology.

This article presents an overview of the curriculum deemed essential for trainees in pathology, with mapping to the Milestones competency statements. The means by which these competencies desired for pathology graduates, and ultimately practitioners, can best be achieved is discussed. The value of case (problem)-based learning in this realm, in particular the kind of integrative experience associated with hands-on projects, to both cement knowledge gained in the lecture hall or online and to expand competency is emphasized.

Usability and reliability of a remotely administered adult autism assessment, the autism diagnostic observation schedule (ADOS) module 4.

INTRODUCTION: The Autism Diagnostic Observation Schedule (ADOS) Module 4 is an autism assessment designed for verbally fluent adolescents and adults. Because of a shortage of available clinical expertise, it can be difficult for adults to receive a proper autism spectrum disorder (ASD) diagnostic assessment. A potential option to address this shortage is remote assessment. The objective of this study was to examine the feasibility, usability, and reliability of administering the ADOS Module 4 remotely using the Versatile and Integrated System for Telerehabilitation (VISYTER). MATERIALS AND METHODS: VISYTER consists of computer stations at the client site and clinician site for video communication and a Web portal for managing and coordinating the assessment process. Twenty-three adults with an ASD diagnosis participated in a within-subject crossover design study in which both a remote ADOS and a face-to-face ADOS were administered. After completing the remote ADOS, participants completed a satisfaction survey. RESULTS: Participant satisfaction with the remote ADOS delivery system was high. The kappa value was greater than 0.61 on 21 of 31 ADOS items. There was substantial agreement on ADOS classification (i.e., diagnosis) between assessments delivered face-to-face versus assessments delivered remotely (interclass coefficient=0.92). Non-agreement may have been due to outside factors or practice effect despite a washout period. CONCLUSIONS: The results of this study demonstrate that an autism assessment designed to be delivered face to face can be administered remotely using an integrated Web-based system with high levels of usability and reliability.

Assistive technology and veterans with severe disabilities: examining the relationships among race, personal factors, medical support, income support, and use.

PURPOSE: Examine the relationship among assistive technology (AT), race, and other demographic characteristics (eg, sex, educational attainment, and employment status), medical coverage, as well as government support for veterans with severe disabilities. METHODS: Data were analyzed from the Rehabilitation Services Administration-911 dataset collected in the United States in 2012. Descriptive and multivariate analyses were performed. RESULTS: Among veterans with severe disabilities, factors that increased AT usage for European Americans (EAs) and African Americans (AAs) were employment, medical coverage (eg, access to private insurance and Medicare), government support (eg, Supplemental Security Income or Social Security Disability Income), and having a sensory type of disability. Having a mental disability was associated with decreased use of AT for EAs and AAs. Whereas EAs) had more factors associated with a decreased likelihood of using AT, AAs had more factors associated with an increased likelihood. For EA veterans with severe disabilities, receiving Medicaid, veteran benefits, and Workers' Compensation were associated with a decreased likelihood of using AT. AA veterans with severe disabilities were 60% less likely to use AT compared with EAs. CONCLUSIONS: Racial differences between AAs and EAs were observed in the use of AT by veterans with severe disabilities based on sex, education, employment status, medical coverage, and government support. AAs were generally less likely to use AT; however, greater exposure to resources such as employment, insurance, and government income support partially explained the differential AT use between EAs and AAs. Future policies and research should address these racial disparities in veterans with severe disabilities to promote equitable AT use and healthy functioning.

Utilization of assistive technology by persons with physical disabilities: an examination of predictive factors by race.

PURPOSE: Examine the relationship between race, use of assistive technology (AT), gender, educational attainment, income, employment status and access to health care. METHODS: Data were analyzed from the national Behavioral Risk Factor Surveillance System (BRFSS) collected in USA in 2007. Descriptive statistics and logistic regression were performed. RESULTS: Among those who used AT, more European Americans (EAs) were educated, employed, made >$25,000 per year and had better access to health coverage. In contrast, more African Americans (AAs) who used AT were less educated, unemployed, made <$25,000 per year and had worse health coverage. Overall, AAs used AT more than EAs. The trend was consistent with predictive factors. AAs were 29% more likely to use AT compared to EAs. For EAs and AAs, predictors for use of AT were age, gender, education, employment status, income, health coverage and medical costs. CONCLUSIONS: Racial differences between AAs and EAs were observed in the use of AT by persons with physical disabilities based on age, gender, education, employment status, income levels, health care coverage and medical costs. Even though EAs and AAs had the same predictors, there were racial differences in the magnitude of the predictors.

Racial and ethnic disparities in employment outcomes for persons with traumatic brain injury: a longitudinal investigation 1-5 years after injury.

OBJECTIVE: To determine whether differences exist in employment rates between whites, blacks, and Hispanics with traumatic brain injury (TBI) at 1, 2, or 5 years after injury; to determine whether changes occur in postinjury employment rates over time for whites, blacks, and Hispanics; and to determine whether changes in postinjury employment rates over time are different for whites, blacks, and Hispanics. SETTING: Sixteen TBI Model System centers. PATIENTS OR OTHER PARTICIPANTS: Persons (3,940) with moderate-to-severe TBI who self-reported as white, black, or Hispanic. MAIN OUTCOME MEASUREMENTS: Employment status dichotomized as competitively employed versus not competitively employed. RESULTS: The odds of competitive employment were significantly greater for whites versus blacks at 1, 2, and 5 years after injury and were greater for whites versus Hispanics at 1 and 2 years after injury; whites and Hispanics did not differ significantly at 5 years after injury; and blacks and Hispanics were not significantly different at 1, 2, or 5 years after injury. The odds of employment increased significantly from 1-2, 2-5, and 1-5 years after injury for whites and Hispanics, whereas the odds of employment increased from 2-5 and 1-5 years after injury for blacks, with no significant difference between 1 and 2 years after injury for blacks. No evidence was found that the changes in employment rates over time were significantly different among the race and/or ethnicity groups. CONCLUSION: Future researchers should seek to identify causative factors for employment disparities, and rehabilitation professionals should work to mitigate inequalities in employment among racial and ethnic groups with TBI.

Interlimb coupling from the arms to legs is differentially specified for populations of motor units comprising the compound H-reflex during "reduced" human locomotion.

Recent experiments have identified neuromechanical interactions between the arms and legs during human locomotor movement. Previous work reported that during the rhythmic movement of all four limbs, the influence of the arms on reflex expression in the legs was superimposed on the dominant effect of the legs. This evidence was based upon studies using cutaneous and H-reflex modulation as indices of neuronal activity related to locomotion. The earlier H-reflex study was restricted to one phase of movement and to only a fixed H-reflex amplitude. Also, all four limbs were actively engaged in locomotor movement, and this led to the speculation that the effect from the arms could be underestimated by "swamping" of the conditioning during movement of the test limb. Work from the cat suggests that descending locomotor drive may be differentially specified for different motor unit populations in the hindlimb. Accordingly, details of interlimb coordination between the arms and legs in humans require further characterization and an examination of different populations of motor units as can be obtained from H-reflex recruitment curve (RC) parameters. Using modulation of H-reflex amplitudes across the entire ascending limb as neural probes for interlimb coupling, the present study evaluated the separated influences of rhythmic activity of the arms and leg on neuronal excitability of a stationary "test leg". This three-limb "reduced" locomotion approach was applied using a stepping ergometer during the performance of three rhythmic movement tasks: arms (A); contralateral leg (L); and arms and contralateral leg (AL). Data were sampled at four different phases of the stepping cycle (using the moving leg as reference): start power (SP); end power (EP); start recovery (SR); and end recovery (ER). The main result was a large and significant influence of rhythmic AL activity on RC parameters of the H-reflex at EP and SP phases. However, the parameters (and thus motor unit populations) were differentially affected at each phase and task. For instance, a significant contribution of arms movement was noticed for H (max) (largest motor units) at EP phase (P < 0.05), but no changes was observed for other parameters related to lower reflex amplitude (e.g., H-reflex evoked with an input that elicited 50% of maximum reflex response during static condition; H@50%). On the other hand, at SR phase, the parameter H@50% was significantly affected during AL compared to L. It is suggested that the remote effect from arms rhythmic activity has been differentially manifested across motor unit populations for each phase of movement. These findings provide definitive evidence for interlimb coupling between cervical and lumbar oscillators in gating the excitability of reflex pathways to a leg muscle for different populations of motorneurons within the pool. This further supports the contention of similar functional organization for locomotor networks in the human when compared to other animals. Additionally, these data provide additional confirmation of the significant role of the output of neural control for rhythmic arm movement in modulating reflex excitability of the legs that is specifically adjusted according to the phase and task.

Race, ethnicity, and employment outcomes 1, 5, and 10 years after spinal cord injury: a longitudinal analysis.

OBJECTIVES: (1) To compare the odds of competitive employment versus not competitive employment among a group of white, African American, and Hispanic persons with spinal cord injury (SCI) at 1, 5, and 10 years after injury; (2) to examine the changes in the odds of competitive employment versus not competitive employment over time within each racial/ethnic group, and (3) to compare the changes in the odds of competitive employment versus not competitive employment over time between the racial/ethnic groups. DESIGN: Retrospective study. SETTING: Model SCI systems. PARTICIPANTS: A total of 11,090 persons with SCI (7735 whites, 2381 African Americans, and 974 Hispanics), between ages 18 and 55 years, enrolled in the National Spinal Cord Injury Statistical Center database. MAIN OUTCOME MEASURE: Employment status dichotomized as competitively employed versus not competitively employed. RESULTS: The odds of being competitively employed at 1, 5, and 10 years after injury were 1.58, 2.55, and 3.02, times greater for whites than African Americans and 1.71, 1.86, and 1.71, respectively, times greater for whites than Hispanics. At 10 years after injury, the odds of being competitively employed were 1.77 times greater for Hispanics than for African Americans. Persons of all races/ethnicities and with SCI showed significantly greater increases in the odds of being competitively employed versus not competitively employed over time (1-5 years, 1-10 years, 5-10 years after injury); however, whites and Hispanics had greater increases in the odds of competitive employment over time compared with African Americans. CONCLUSIONS: Regardless of race, short- and long-term employment outcomes were not favorable for persons with SCI; however, African Americans and Hispanics fared worse in employment outcomes compared with whites. Rehabilitation professionals should work to improve employment outcomes for all individuals with SCI, with special emphasis on addressing specific needs of African Americans and Hispanics.

Disability disparities: a beginning model.

This paper presents a model of disability disparities. Though the concept of health disparities is discussed in the health care literature, there is no such model that explicitly addresses disparities in the disability literature. Therefore, this model begins to fill a void in the disability literature. Part of the value of such a model is that it represents an attempt to address the question of why cultural competency is important in the disability arena at this point in the 21st century. The urgency in addressing cultural competency at this time in history is supported by understanding the multiple accountability demands on rehabilitation and disability providers these days, e.g., increasing diversification of the United States population, that render providing effective services to everyone a clear mandate. The author provides a working definition of disability disparity. The disability disparity model is described in terms of its five-domain continuum as well as its macro- and micro-level aspects that are designed to both promote clarity of the concept for researchers and offer practitioners ideas on how to explore the existence of disability disparities in working with specific service recipients. Limitations and strengths of the model are discussed along with suggested next steps in model validation.

Integrating cultural competency in rehabilitation curricula in the new millennium: keeping it simple.

Pre-service rehabilitation education programmes in the United States still prepare future professionals in cultural competency primarily through one required course in multicultural counselling, though there is an expectation that such content will be woven into all graduate rehabilitation coursework. These authors believe that there is still a need in these dawning years of the 21st century to offer more guidance to rehabilitation educators on how to integrate cultural competency into each course at the graduate level. This discussion reviews the literature to date on cultural competency within rehabilitation education in the United States, then concludes by proposing a four-strategy framework for use by rehabilitation educators that is simple, comprehensive, multi-dimensional (i.e., it addresses faculty awareness, student coursework, the student clinical experience and lifelong learning for the student after exiting the pre-service educational programme), and that offers clear guiding parameters without being overly prescriptive.