Browsing by Subject "rehabilitation"
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Item Arthritis impact on the physical function, disability, and health-related quality of life among older Mexican-Americans(2009-03-02) Saad M. Bindawas; Elizabeth J. Protas, P.T., Ph.D.; Yong-fang Kuo, Ph.D.; Soham Al Snih, M.D., Ph.D.; Kenneth J. Ottenbacher, O.T.R., Ph.D.; Dennis L. Hart, P.T., Ph.D.; Anita C. Mercado, M.D.Background and Purpose: Arthritis is a major cause of disability with a sizable impact on health-related quality of life (HRQoL) in older adults, especially among older non-Hispanic white subjects. The purpose of this study is to examine the relation between arthritis and its effects on the physical function, disability, and health-related quality of life, over time, among older Mexican-Americans, the fastest growing subset of the older population. \r\nDesign: A six-year prospective cohort study (2000 to 2006). Setting: Five Southwestern states: Texas, New Mexico, Colorado, Arizona, and California. \r\nParticipants: A population-based sample of 621 non-institutionalized Mexican-Americans aged 65 or older from wave four of the Hispanic Established Population for Epidemiologic Studies of the Elderly (Hispanic EPESE). \r\nMeasurements: Included sociodemographic variables, self-reported of: arthritis, pain on weight-bearing, activities of daily living (ADL), instrumental activities of daily living (IADL), physical and mental HRQoL, medical conditions, cognitive function and depressive symptoms. Lower and upper extremity muscles strength, lower body function test and body mass index (BMI) were also obtained. General linear mixed models and generalized estimating equations (GEE) were used to examine the time effect on: 1) each stage of the disablement process and 2) physical and mental HRQoL over three points of time (2000-2001, 2001-2002, and 2006). This study conforms to STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) guidelines for cohort studies. \r\nResults: The results indicate 1) a significant association between arthritis and greater impairment (pain and poor muscle strength), functional limitation, disability (ADL and IADL), and physical HRQoL across time; and 2) a significant association between impairment, functional limitation, and IADL limitation with physical and mental HRQoL across time. Conclusions: In older Mexican-Americans, arthritis is a highly prevalent medical condition which significantly impacts physical function, daily activities, and physical HRQoL over time. In this cohort, impairment, functional limitation, and disability were associated with poorer physical and mental HRQoL. These findings could guide efforts in reaching the goals of the National Arthritis Action Plan, as well as the Healthy People 2010 initiative goals of increasing quality of life and eliminating health disparities in this segment of the older U.S. population.Item Change in positive emotion and recovery of functional status following stroke rehabilitation in older adults(2010-04-26) Gary Steven Seale; Glenn V. Ostir, Ph.D.; Yong-fang Kuo, Ph.D.; Timothy R. Elliott, Ph.D.; Kenneth J. Ottenbacher, Ph.D.; Beatriz C. Abreu, Ph.D.Stroke is a leading cause of disability in the United States and represents a major public health challenge. Recovery of functional status following stroke is a primary focus for rehabilitation, and is an important health outcome linked to independence, life satisfaction and quality of life. Among factors associated with recovery of functional status following stroke is positive emotion. In elderly populations, positive emotion has been shown to be protective of stroke and has been associated with functional recovery following stroke. However, most studies examining the relationship between positive emotion and recovery of functional status evaluate positive emotion at a single time point, and over relatively brief follow-up periods. Some studies report positive emotion may be a dynamic process and can change over brief periods of time. Not clear is whether positive emotion continues to change over longer time periods and whether change in positive emotion can influence recovery of functional status post stroke. \r\nThe purpose of this study was to examine change in positive emotion over a 12-month follow-up period and to determine whether change in positive emotion was associated with recovery of functional status following rehabilitation for first time stroke in an elderly, ethnically diverse patient population. This secondary analysis of data was collected on 990 older adults with first time stroke admitted to one of 20 acute medical rehabilitation facilities in the United States between 2005 and 2006. Data were examined at discharge from acute medical rehabilitation, and at 3-month and 12-month follow-up. The 12-month follow-up sample was comprised of 684 non-Hispanic whites, non-Hispanic blacks, and Hispanics aged 55 or older with first time stroke. \r\nKey findings of this study included: 1) positive emotion changed over the 12-month follow-up period with the majority of change occurring between discharge and 3-month follow-up, 2) of the patients who demonstrated change in positive emotion, more demonstrated an increase in positive emotion over the 12-month follow-up as compared to no change or a decline, 3) change in positive emotion was significantly associated with recovery of functional status post stroke after controlling for important sociodemographic characteristics and clinical measures known to impact recovery after stroke, including depressive symptoms.\r\nChange in positive emotion can occur over relatively long periods of time (i.e., 12 months) and this change is associated with recovery of functional status post stroke. \r\nItem Change in positive emotion and recovery of functional status following stroke rehabilitation in older adults(2010-04-26) Gary Steven Seale; Glenn Ostir, PhD; Yong-fang Kuo, PhD; Timothy R. Elliott, PhD; Kenneth Ottenbacher, PhD; Beatriz C. Abreu, PhDStroke is a leading cause of disability in the United States and represents a major public health challenge. Recovery of functional status following stroke is a primary focus for rehabilitation, and is an important health outcome linked to independence, life satisfaction and quality of life. Among factors associated with recovery of functional status following stroke is positive emotion. In elderly populations, positive emotion has been shown to be protective of stroke and has been associated with functional recovery following stroke. However, most studies examining the relationship between positive emotion and recovery of functional status evaluate positive emotion at a single time point, and over relatively brief follow-up periods. Some studies report positive emotion may be a dynamic process and can change over brief periods of time. Not clear is whether positive emotion continues to change over longer time periods and whether change in positive emotion can influence recovery of functional status post stroke. \r\nThe purpose of this study was to examine change in positive emotion over a 12-month follow-up period and to determine whether change in positive emotion was associated with recovery of functional status following rehabilitation for first time stroke in an elderly, ethnically diverse patient population. This secondary analysis of data was collected on 990 older adults with first time stroke admitted to one of 20 acute medical rehabilitation facilities in the United States between 2005 and 2006. Data were examined at discharge from acute medical rehabilitation, and at 3-month and 12-month follow-up. The 12-month follow-up sample was comprised of 684 non-Hispanic whites, non-Hispanic blacks, and Hispanics aged 55 or older with first time stroke. \r\nKey findings of this study included: 1) positive emotion changed over the 12-month follow-up period with the majority of change occurring between discharge and 3-month follow-up, 2) of the patients who demonstrated change in positive emotion, more demonstrated an increase in positive emotion over the 12-month follow-up as compared to no change or a decline, 3) change in positive emotion was significantly associated with recovery of functional status post stroke after controlling for important sociodemographic characteristics and clinical measures known to impact recovery after stroke, including depressive symptoms.\r\nChange in positive emotion can occur over relatively long periods of time (i.e., 12 months) and this change is associated with recovery of functional status post stroke. \r\nItem The impact of race/ethnicity on post acute services(2009-02-24) Tracy U Nguyen-Oghalai; Jean Freeman; Terry A McNearney; Kenneth J Ottenbacher; James S Goodwin; Huifang LuEach year, more than 300,000 people fracture their hip. The number of hip fractures in the US is expected to increase with the aging of the population in the coming years; by 2040, 500,000 patients annually will sustain a hip fracture. Better understanding of factors impacting outcomes after hip fractures can inform the health care work force, facilitate future interventions to improve outcomes for patients with hip fractures and inform future health policy. This dissertation reviewed the impact of race/ethnicity and comorbidity on perioperative and subacute hip fracture management and discussed the implications for future medical management and health policy.Item Life Satisfaction Over the First Five Years Following Burn Injury(2012-10-19) Hoskins, Jessica LynneIndividuals with burn injuries increasingly survive their injury, but we know little about their psychological outcomes following the injury. This study examines life satisfaction outcomes for 260 individuals who sustained burn injuries and were assessed repeatedly over a five year period post-discharge with the Life Satisfaction Index (LSI), Functional Independence Measure (FIM), and Family Satisfaction Scale (FSS). Structural equation modeling was used to predict life satisfaction (LSI) based on functional impairment (FIM), family satisfaction (FSS), pain, and employment variables. Study participants were assessed at 12 months, 24 months, 48 months, and 60 months post discharge. Each time period assessed was analyzed as a model of life satisfaction predictors; additionally, a prospective model was proposed which combined data from all four time points in one path analysis of predictors of life satisfaction at 60 months post discharge. Results indicate that family satisfaction, functional independence, employment, and pain did not explain the variance associated with life satisfaction scores (variance explained ranged from 4% at 24 months post discharge to 11% at 60 months post discharge). Few paths in all five of the models proposed proved significant, suggesting that other factors influence life satisfaction in individuals with burn injuries. These results constitute an important addition to the limited literature surrounding psychological outcomes of those who suffer burn injury and have implications for future studies to advance research on this issue.Item Rehabilitation Techniques and Assessment of a Historic Reinforced Concrete Variable Depth Girder Bridge(2013-05-08) Ortiz, Laura MarieHistoric bridges are an important part of the nation's infrastructure. However, many historic bridges are not being maintained to a level that will ensure their continued use. In 2007, the I-35 W Mississippi River Bridge collapsed demonstrating significant issues with the safety of older bridges in service. Currently there are so many bridges that are considered structurally deficient that transportation authorities are continuously faced with the dilemma of distributing limited bridge funds. This situation underscores a need for cost effective and reliable maintenance and rehabilitation strategies. This thesis promotes historic preservation in two main tasks: (1) rehabilitation and repair methods are determined to guide engineers, preservationists, and other stakeholders and (2) an assessment is performed for a prototype historic bridge. More specifically, the assessment is performed in three tasks: (1) modeling of the historic bridge, (2) evaluation of the bridge using load rating procedures, and (3) rehabilitation strategies are recommended based on the results of the assessment. The prototype bridge is a 1930s variable depth T-beam bridge. The bridge did not meet requirements for flexural capacity at the mid-sections of the approach and main span interior girders. Three rehabilitation methods considered were support modification at the cantilever ends, external fiber reinforced polymer (FRP) plies, and external post-tensioning. The support modification raised the bridge to a 75-year exposure period, the highest level of evaluation, without disrupting the historical integrity of the bridge. The FRP plies raised the positive moment capacity of the bridge to legal load standards, a 5-year exposure period. The FRP retrofit was limited by de-bonding issues. The external post-tensioning raised the positive capacity to design load standards at the inventory level, a 75-year exposure period. The external post-tensioning was limited by the use of a straight tendon, but is less visible than a draped tendon. From the information in the assessment, support modification is more effective than the other methods and will not negatively affect the bridge?s historic integrity. Other factors such as the projected effects on other bridge elements including the substructure, cost, installation procedures, and durability should be considered and might lower the benefits of the considered methods.Item Texas prison rehabilitation: can it work?(Law Enforcement Management Institute of Texas (LEMIT), 2015) Pulaski, StephenItem The evolution of post-stroke depressive symptoms across rehabilitation and discharge settings(Texas A&M University, 2004-11-15) Long, James R.Previous literature has shown that depression is the most common major emotional result following a stroke. Although the prevalence and severity of this issue have been well documented, limited research has been done to identify the evolution of post-stroke depressive symptoms in the acute phase following a stroke. During this period of time, the patient is faced with a number of significant changes from his / her previous level of functioning. These issues can include loss of physical functioning, loss of independence, changes in living arrangements, and an increased reliance on the support and care of others. The purpose of the current study was to examine fluctuations in depressive symptoms as each participant progressed through rehabilitation and discharge, and to gather qualitative information pertaining to the contributing factors that could play a role in this issue. A sample of nine participants between the ages of 50 and 85 was obtained from a regional rehabilitation unit. Data and clinical information were collected using an intensive case study design. Participants were asked to complete the Geriatric Depression Scale (GDS) at three-day intervals while on the rehabilitation unit and following discharge. This information was interpreted in the context of qualitative information gathered through reports from the participant, his or her significant other / family member, nursing and professional staff members on the rehabilitation unit, and patient records. Other analyses performed included an examination of the interactions between performance and motivation during the rehabilitation process and role of discharge site in the development and course of depressive symptoms. When examined as a whole, the information collected across all nine participants would suggest that following discharge there was a statistically significant increase in the level of post-stroke depressive symptoms. While the individuals were on the rehabilitation unit, the depressive symptoms decreased significantly and this trend continued following discharge, but the slope was not as significant as that which was observed on the rehabilitation unit. The results also suggested that there is a significant difference between the progression of depressive symptoms between groups separated based on discharge site.Item Towards a culture of sustainable preservation : sustainable design, historic preservation, and cultures of building(2009-05) Kleon, Meghan F.; Moore, Steven A., 1945-; Holleran, MichaelThe growing sustainable design movement in the United States focuses almost exclusively on the construction of new buildings, largely ignoring the existing and historic building stock that constitutes the majority of our built environment. Historic preservation, a discipline that deals exclusively with the existing building stock and puts an emphasis on long-term management of the built environment, would seem to be an ideal partner for the sustainable design movement as it begins to address existing buildings. The practice and goals of the two fields, however, are currently perceived to be in opposition to one another by the building community and the general public. This thesis argues that sustainable design and historic preservation represent two unique and distinctive building subcultures – distinct subsets of the larger building culture of which they are a part, and that the opposition between the two disciplines stems from not only their historically distinct discourses, but also from cultural and ideological conflicts between the two fields. Different languages, code typologies, cultural identities, and conflicting attitudes toward the use of technology in contemporary building practice all stand as barriers to a significant partnership between the two disciplines. This thesis explores the cultures of sustainable design and of historic preservation in order to provide a view for practitioners in both fields into the culture of the other, and ultimately proposes a path towards developing shared cultural understandings by placing a new emphasis in both fields on social sustainability.Item Trajectories of Happiness Following Acquired Disability(2013-07-09) McCord, Carly ElizabethCurrent deficits in the rehabilitation psychology literature involving longitudinal studies investigating positive outcomes following acquired disabilities have deserved research attention. In the current study, data on happiness as an enduring mood tone, as measured by the Life Satisfaction Index (LSI) was collected from 1271 individuals (?insiders?) having incurred either a traumatic brain injury (TBI), spinal cord injury (SCI), severe burn, or intra-articular fracture (IAF) or from someone who felt close enough to speak on their behalf (?outsiders?). Data on happiness, functional independence as measured by the Functional Independence Measure (FIM), and other variables of interest were collected at 12 months, 24 months, 48 months, and 60 months after being medically discharged. Hierarchical Linear Modeling (HLM) analyses showed that trajectories of happiness remained stable across participants and did not change significantly over five years post-discharge regardless of injury type, FIM, or insider/outsider status. Happiness was significantly predicted by FIM, injury type, and whether the respondent was an insider or outsider. Those who were more impaired and less functionally independent were less happy. Those with a TBI were consistently less happy than those with an IAF or SCI and outsiders reported greater happiness on behalf of the insider than did the insiders themselves. This study shows that there is stability in happiness levels that can be sustained at least five years post-discharge and that there are discrepancies between insider and outsider reports of subjective happiness. Proxy reports can be used as valuable and valid secondary sources of information but should not be used as substitutes for first hand reports unless absolutely necessary.Item Wireless Sensor Network for Monitoring of Historic Structures under Rehabilitation(2012-02-14) Samuels, Julie MarieThe use of a wireless sensor network (WSN) to monitor an historic structure under rehabilitation is the focus of this research. To thoroughly investigate the issue, two main objectives are addressed: the development of a reliable WSN tailored for use in historic structures, and the implementation of the monitoring system in the field to test the feasibility of the WSN and its applicability for structural health monitoring (SHM). Three field studies are undertaken in this research. The Frankford Church, an historic wooden church which required foundation replacement, is the first field study. Sensors monitor tilt of the church?s walls throughout construction. During the construction process, the entire floor of the church is removed and the tree stump foundations are replaced by concrete masonry unit (CMU) blocks and steel pedestals. The tilt in the walls is correlated to the construction process. St. Paul Lutheran, an historic masonry church with timber-framed roof, constitutes the second field study. In this structure, the foundations along the exterior walls are underpinned and the floors are removed and replaced with a floating concrete slab. Detected movements are also correlated to the construction efforts. The Johanniskirche, an historic masonry church with moisture problems, is the final field study case. Real-time and past measured WSN climate data is used to determine the most appropriate solution for the humid climate and resulting condensation problems in this structure. From these results, a moisture migration risk analysis protocol is created for use with a WSN to address condensation issues. The results of the tilt monitoring indicate that the approach is realistic to monitor tilt in the walls of historic structures. For future research, it is recommended to implement motes with higher tilt sensitivity. Also, further development of energy saving algorithms and energy harvesting methods will improve the WSN?s performance. Climate monitoring results show it is feasible to monitor climate conditions of historic structures. The moisture migration protocol provides a basis for further improvement. Implementation of this tool will help predict condensation events and prevent future damage to the historic structure.