Enhanced neurorehabilitation techniques in the DVBIC Assisted Living Pilot Project.

Traumatic Brain Injury has been labeled the "silent epidemic" in our current wars. Both CBO and the RAND reports predict that the costs of these injuries will be both extensive and enduring. The projected costs are based not only upon the loss contribution of these warriors to our economy, but also the long-term medical and assistive care that will be needed to support these veterans for decades to come. Thus, the primary goal of the Assisted Living Pilot Project (ALPP) at the Defense and Veterans Brain Injury Center - Johnstown (DVBIC-J) is to promote the ability of the injured warrior to move from assisted living to living independently and to be self-supporting by providing a continuum of care. To accomplish this goal the DVBIC-J ALPP is providing full set of traditional services (physical, occupational, speech, psychological/cognitive, social/familial, vocational, and spiritual), along with "cutting-edge" rehabilitative treatment technologies. These cutting-edge therapies include transdisciplinary clinical consultations, interactive patient and family counseling, and telemedicine-teleconferencing for clinical evaluations and family/significant other care participation. These services will be available to those who require assisted living through their progression to community re-entry. The ALPP also serves as a vehicle for clinical trials to investigate the effects of an enriched environment (e.g., recreational therapies, massage, multisensory stimulation, etc.) on neurorehabilitation therapy, rural telemedicine for servicemembers with traumatic brain injury, and long-term outcome measures of those who have received neurorehabilitation services at the DVBIC-J site. DVBIC-J is also developing collaborative projects with universities and private industry to create an incubator for new rehabilitation technologies. The technologies that DVBIC-J will be focusing on will include assistive technologies (to assist cognitive, physical, and communicative impairments), virtual and augmented reality simulations (for both diagnosis and treatment of TBI and PTSD), and telecommunication technologies to improve rehabilitation services to those warriors that have returned to their homes in rural areas.

Ability of Functional Independence Measure to accurately predict functional outcome of stroke-specific population: systematic review.

Stroke is a leading cause of functional impairments. The ability to quantify the functional ability of poststroke patients engaged in a rehabilitation program may assist in prediction of their functional outcome. The Functional Independence Measure (FIM) is widely used and accepted as a functional-level assessment tool that evaluates the functional status of patients throughout the rehabilitation process. From February to March 2009, we searched MEDLINE, Ovid, CINAHL, and EBSCO for full-text articles written in English. Article inclusion criteria consisted of civilian and veteran patients posthemorrhagic and ischemic stroke with an average age of 50 years or older who participated in an inpatient rehabilitation program. Articles rated 5 or higher on the PEDro (Physiotherapy Evidence Database) scale were analyzed, including one cluster randomized trial and five cohort studies. Descriptive and psychometric data were outlined for each study. Key findings, clinical usefulness of the FIM, potential biases, and suggestions for further research were summarized. Although limited, evidence exists that FIM scores can be used as an accurate predictor of outcomes in poststroke patients.