Evaluation of a Novel Ostomy Barrier Ring with Assisted Flow for Individuals with an Ileostomy.

OBJECTIVE: To determine the performance and user experience of a novel ostomy barrier ring over a 4-week period. METHODS: This single-arm investigation conducted across three clinical sites included 25 adult participants with an ileostomy for 3 months or longer. The participants used their standard ostomy pouching appliance along with a novel barrier ring for a period of 4 weeks. Skin condition was assessed using the Ostomy Skin Tool. Change in skin condition over the study period was recorded for each participant. The participants' experience in using the novel barrier ring was measured using a five-point Likert-type scale. RESULTS: Twenty of the 25 participants (80%) completed the trial. Of those participants, the median Ostomy Skin Tool score at both the beginning (range, 0-8) and end was 0 (range, 0-6). In terms of skin condition, 7 participants experienced an improvement in skin condition, 11 experienced no change, and 2 got worse. A median score of 5 out of 5 was recorded for all questions relating to user experience. CONCLUSIONS: Although not statistically significant, there was a clear trend toward improvements in peristomal skin condition using the novel barrier ring, even for participants who were already using a barrier ring. User feedback was positive with respect to comfort, device handling, and the perception of the device's ability to protect the skin. Further, most participants who already used a barrier ring indicated that the novel barrier ring would result in a longer wear time.

Effects of skin moisturizer on the skin barrier dysfunction model: An evaluation of the heel via tape-stripping in healthy, young adults.

BACKGROUND: This study seeks to establish the skin barrier dysfunction model at the heel via tape-stripping (TS) by evaluating the skin moisturizing effects. MATERIALS AND METHODS: Nineteen young, female participated in the study. A sequence of TS was performed at the heel and trans-epidermal water loss (TEWL), stratum corneum (SC) hydration, and surface pH were measured. Following TS, the subjects were divided into three groups: moisturizer, emollient, and overcoat. These agents were applied daily at night, and the skin parameters were measured the next morning for a week. RESULTS: The TEWL value of TS immediately and 5 min after TS were significantly higher than what was obtained before TS, while the SC hydration after TS was significantly lower than what was obtained before TS. However, there were no significant differences in the skin parameters among the three agents on day 7 after application, with the two-way ANOVA showing no interaction among the agents and number of days. CONCLUSION: The skin barrier dysfunction model at the heel was established by TS in healthy, young adults. However, the physiological function of the skin at the heel did not change drastically and showed no differences even after continuous application for 7 days.

Ramps remain a barrier to safe wheelchair user transit bus ingress/egress.

Background: Wheelchair users (WCUs) often rely on ramps for access to transit buses. Previous studies indicate WCUs have difficulty using ramps for bus ingress/egress and many transportation-related incidents occur on ramps. However, experiences of WCU ramp usage during ingress/egress have not been fully described.Methods: Cross-sectional, internet-based survey of WCUs who ride transit buses was conducted. The participants were queried on frequency of bus usage, difficulty and incidents involving ramps, and factors contributing to difficulty and incidents. Wheelchair characteristics, primary condition, and whether participants received travel training were also captured. Chi-square was used to describe relationships between wheelchair type and frequency of difficulties and incidents, and odd ratios were used to determine likelihood of the incidents.Results: The majority (55.7%) of 384 participants reported using public transportation ≥ 1 per week. Seventy-eight percent of WCUs had ≥ 1 ramp incident over the past 3 years, with an increased likelihood of incidents occurring during ingress (OR = 1.53; CI 1.21-1.86). Of those who had an incident, 22% were injured or had damage to their wheelchair. Over 60% of those who had an incident identified steep ramp slope as being the contributing factor. Steep ramp slope, exterior ramp thresholds and wet surfaces were the most common contributing factors to difficulty using ramps.Conclusion: This is the first large-scale US study enabling WCUs to describe their experiences using transit bus ramps. Despite ADA guidelines, steep ramps remain the primary factor contributing to incidents and difficulty when using ramps to access transit buses.Implications for rehabilitationThe discrepancy between ADA maximum allowable ramp slopes for the built environment and transit buses may require an increased level of effort that is a barrier to transportation accessibility for some wheelchair users.Wheelchair users who access transit buses should be made aware of, and trained, to navigate ramp configurations found in the environment.We suggest rehabilitation therapists provide skills training specific to navigating transit bus ramp slopes that may be steeper and narrower than building ramps.

Evaluating the Functionality and Usability of Two Novel Wheelchair Anti-Rollback Devices for Ramp Ascent in Manual Wheelchair Users With Spinal Cord Injury.

BACKGROUND: Difficulty ascending ramps and inclines with a manual wheelchair adversely affects the everyday mobility and overall quality of life of manual wheelchair users. Currently, various anti-rollback devices are available to assist manual wheelchair users to ascend ramps and inclines. However, these devices have 2 main shortcomings: restriction to backward motion limiting recovery from an overturning wheelchair, which is a safety concern; and difficulty in engaging/disengaging the device while on the ramp. OBJECTIVE: To evaluate the functionality and usability of 2 novel wheelchair anti-rollback devices developed to address these shortcomings (prototypes "Wheel" and "Brake"). DESIGN: Cross-sectional. SETTING: Rehabilitation research facility. PARTICIPANTS: Twelve adult participants with chronic spinal cord injury. METHODS: Participants completed training and tested with both the wheelchair anti-rollback devices on a 7.3-m-long ramp. MAIN OUTCOME MEASUREMENTS: Number of stops, perceived physical exertion, pain, and ease of use of these devices as participants maneuvered their wheelchairs up a 7.3-m ramp were assessed. Participants also evaluated their satisfaction with the usability of both the devices using the Quebec User Evaluation of Satisfaction With Assistive Technology (QUEST 2.0). RESULTS: Both prototypes evaluated overcame the limitations of the existing anti-rollback devices. Nonparametric statistical tests showed that participants rated both prototypes similarly for the overall functional and usability aspects. However, the participants' satisfactory rating were higher for the prototype "Brake" than for the prototype "Wheel" based on a functional aspect (ie, engaging/disengaging easiness), and higher for Wheel than for Brake, based on a usability aspect (prototype size). CONCLUSIONS: The qualitative and quantitative outcomes of this investigation, based on the usability and functional evaluations, provided useful information for the improvement in the design of both anti-rollback devices, which may allow manual wheelchair users to manage ramp ascent more safely and easily. Further evaluations with a different SCI population is recommended. LEVEL OF EVIDENCE: IV.

User perceptions of existing home access solutions and a novel home access device.

PURPOSE: This study aimed to evaluate end user perspectives of four existing home access solutions (HAS) and a newly designed experimental device (the ARISE). METHOD: A cross-sectional design was used to evaluate the ARISE prototype against other HAS. Specifically, participants trialed stairs, a ramp, a platform lift (PL), a stair glide and the ARISE, after which they completed questionnaires aimed at soliciting their perspectives of these solutions. The time taken by participants to use each HAS was also collected. RESULTS: Five HAS design features were deemed as important by 90% of participants: ease of use, ability to use independently, reliability, safety and security. Time taken to use each HAS from fastest to slowest was: stairs, the ARISE, ramp, PL and stair glide. The ARISE prototype was rated as the first or second most preferred device by the most number of participants, followed by the PL, then the ramp. CONCLUSIONS: Results from this study provide greater understanding of user perspectives of HAS. End user feedback on a novel prototype device has provided valuable insight into its usability and function, which should not only guide future development of this device, but also provide direction for other innovations around home access. Implications for Rehabilitation It is anticipated that gaining a better understanding of strengths and weaknesses of home access solutions will: assist clinicians and end users in finding solutions that meet the individuals' needs. lead to the development of new or improved solutions that more closely address user needs. encourage further innovation in the area.

Influence of priming exercise on muscle deoxy[Hb + Mb] during ramp cycle exercise.

The aim of the present study was to gain better insight into the mechanisms underpinning the sigmoid pattern of deoxy[Hb + Mb] during incremental exercise by assessing the changes in the profile following prior high-intensity exercise. Ten physically active students performed two incremental ramp (25 W min(-1)) exercises (AL and LL, respectively) preceded on one occasion by incremental arm (10 W min(-1)) and on another occasion by incremental leg exercise (25 W min(-1)), which served as the reference test (RT). Deoxy[Hb + Mb] was measured by means of near-infrared spectroscopy and surface EMG was recorded at the Vastus Lateralis throughout the exercises. Deoxy[Hb + Mb], integrated EMG and Median Power Frequency (MdPF) were expressed as a function of work rate (W) and compared between the exercises. During RT and AL deoxy[Hb + Mb] followed a sigmoid increase as a function of work rate. However, during LL deoxy[Hb + Mb] increased immediately from the onset of the ramp exercise and thus no longer followed a sigmoid pattern. This different pattern in deoxy[Hb + Mb] was accompanied by a steeper slope of the iEMG/W-relationship below the GET (LL: 0.89 ± 0.11% W(-1); RT: 0.74 ± 0.08% W(-1); AL: 0.72 ± 0.10% W(-1)) and a more pronounced decrease in MdPF in LL (17.2 ± 4.5%) compared to RT (5.0 ± 2.1%) and AL (3.9 ± 3.2%). It was observed that the sigmoid pattern of deoxy[Hb + Mb] was disturbed when the ramp exercise was preceded by priming leg exercise. Since the differences in deoxy[Hb + Mb] were accompanied by differences in EMG it can be suggested that muscle fibre recruitment is an important underlying mechanism for the pattern of deoxy[Hb + Mb] during ramp exercise.

Adding additional grab bars as a possible strategy for safer hospital stays.

Patient room design should fulfill the safety needs of most patients. This article addresses the safety concerns related to grab bars and handrails (a United States-based review) and describes our proposed innovative approaches to promote safer hospital stays. The fixed augmentation of high-low grab bars and handrails can economically prevent inpatient falls in the areas commonly used by patients (e.g., patient rooms, patients' bathrooms, and hallways). The optimum grab bar and handrail configurations require further research. Revisions to guidelines for health care facilities related to grab bars and handrails should allow a range that respond to age- and disability-specific needs.

Accessibility of radiology equipment for patients with mobility disabilities.

OBJECTIVE: The purpose was to evaluate accessibility of typical radiology platforms by participants with mobility disabilities. BACKGROUND: These patients have difficulty using radiology equipment and have an increased risk of falling. METHODS: This field study evaluated three common types of radiology platforms - X ray, computed tomography (CT) scan, and fluoroscopy - by 20 patients/participants with mobility impairments who used walking aids. The participants were required to get onto the equipment, simulate a typical radiological procedure, and get off. Each participant then watched a video of his or her own session and answered questions. Four researchers independently reviewed the videotapes and identified accessibility and safety barriers. RESULTS: Overall, the CT scan platform was the easiest to use and the fluoroscopy platform the most difficult, primarily because of platform height differences. Sitting up on the Xray table was rated as difficult by most participants, primarily because of a lack of hand-holds and the surface pad not being fixed in place. Maintaining a position on the fluoroscopy platform while it rotated from horizontal to vertical was difficult and frightening for most participants. CONCLUSION: Some radiology platforms are difficult to use and are perceived to be less safe for patients with mobility disabilities. The interaction of patient disability and equipment design can impose substantial physical demands on medical personnel. Recommendations for improved design are provided to enhance radiology platform accessibility and safety. APPLICATION: The findings may be applicable to the design of a wide range of medical patient platforms.

Unusual form of accidental mechanical asphyxia.

This brief case report shows an unusual form of accidental atypical strangulation. A 46-year-old male became trapped between the rims of an automatically closing door during his hopeless effort to enter a supermarket at night. The victim's neck was violently pressed by the edges of the automatic door. From external observation we found an incomplete ligature mark and numerous small abrasions in the neck. On autopsy we found typical signs of asphyxia and fractures of the hyoid-laryngeal complex and bruising of the soft tissues of the neck. The subsequent toxicology was negative with the exception of alcohol level. We came to the common conclusion of a double form of mechanical asphyxia - atypical violent strangulation and atypical hanging. The third highly likely contributory factor of death was direct stimulation of the baroreceptor nerve endings in the left carotid sinus and left carotid sheath. In recent literature, there have been presented only a few cases describing this manner of asphyxia and death.

Development and validation of AIMFREE: Accessibility Instruments Measuring Fitness and Recreation Environments.

PURPOSE: The purpose of this study was to develop and validate a series of 16 survey instruments measuring fitness and recreation accessibility, collectively referred to as AIMFREE (Accessibility Instruments Measuring Fitness and Recreation Environments). General domains of assessment included the built environment, equipment, programmes, policies, and training and behaviour. METHODS: Fitness and recreation professionals (n=35) assessed fitness centres/swimming pools (n=35) in nine regions across the US. Rasch analysis was used to assess the psychometric properties of the instrument. RESULTS: The AIMFREE evidenced adequate to good fit to the Rasch model and adequate to good internal consistency (r=0.70 - 0.90). Test-retest reliability ranged from 0.70 (entrance areas) to 0.97 (swimming pools). Analysis of differential item functioning indicated that item calibrations generally did not differ significantly between urban and suburban environments. CONCLUSION: The AIMFREE instruments demonstrated adequate to good fit to the Rasch model with several of the subscales demonstrating well to excellent separation of facility accessibility.

A health and demographic profile of noninstitutionalized older Americans residing in environments with home modifications.

OBJECTIVES: In this analysis the authors investigate the demographic characteristics, the health conditions/events, and the disabilities of community-dwelling Americans 70 years of age and older that are associated with residing in environments with specific home modifications. METHODS: Data from a large population-based study of the elderly are used to estimate logistic regression equations that reveal profiles of older individuals who are likely to have distinct home modifications. RESULTS: Having diseases such as diabetes and stroke, having experienced a hip fracture, a fall or a joint replacement, and having greater limitations with activities of daily living raise the likelihood of having home modifications. Low income, Hispanic, and African American elderly appear underrepresented among those with modifications. DISCUSSION: The authors conclude that specialized housing alternatives will be an increasingly important issue in the future as individuals aim to achieve and maintain the delicate balance between their functional ability and their living environment.

Barreras arquitectónicas / Architectonic barrier

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Adaptive air travel transportation systems for persons with disabilities.

The Air Carrier Access Act ensures that no air carrier may discriminate against persons with disabilities. This Act specifies rules and regulations that remove architectural barriers to persons with disabilities. Other important considerations in the comprehensive adaptive air travel system for persons with disabilities include (1) aircraft boarding environment, (2) boarding chairs, (3) collapsible aircraft wheelchairs, (4) aircraft stowage procedures for battery-powered wheelchairs, and (5) airport shuttle bus or van service. Educational curricula must be developed that describe the comprehensive operation of this system. Evaluation of the performance of the system for persons with disabilities is mandatory to ensure that persons with disabilities have the same level of services as those without disabilities.