Engineers at Lehigh and Carnegie Mellon universities, working with a Philadelphia-based start-up, have integrated robotics, laser and wireless technologies into a new system that promises to make it safer and cheaper for wheelchair users to drive a car.

The Automatic Transport and Retrieval System (ATRS), scheduled to go on sale next spring, allows wheelchair users to get in and out of their vehicles, stow and retrieve their chairs, and drive while sitting in standard automobile seats.

The new system is the product of a collaboration between the two universities; Freedom Sciences LLC, a robotics company located at the Philadelphia Navy Yard; and Freedom Lift Corp. of Green Lane, Pa. Freedom Sciences has signed a licensing agreement on the ATRS with Lehigh.

John Spletzer, assistant professor of computer science and engineering, says the ATRS has achieved a breakthrough by enabling wheelchair users to drive while sitting in standard automobile seats that meet federal safety regulations.

Current solutions for wheelchair users who desire independent mobility require operators to sit in their chairs while driving. Because they are often poorly secured and not crash-test-approved, wheelchairs provide far less protection than standard seats. According to the U.S. National Highway Traffic Safety Administration, 35 percent of all automobile fatalities related to wheelchairs result from inadequately secured chairs.

The ATRS is also modular, says Spletzer, and can be installed without making permanent – and expensive – changes to the vehicle. Drivers trading in their cars merely remove the ATRS from the old vehicle and install it in the new one.

By contrast, wheelchairs users who now wish to drive must convert their vehicles, which requires lowering or replacing the floor of their van or minivan; rerouting fuel lines, heating and air-conditioning systems; and relocating the fuel tank.

“These changes severely restrict the resale value of the vehicle,” says Spletzer. “With the ATRS, however, you can buy or lease a vehicle, usually a van, and install the ATRS without making permanent changes to the vehicle. If you decide to buy another vehicle, you simply remove the ATRS, sell or return your van, and install the ATRS in your new vehicle.

“This gives you a lot more freedom and personal choice.”

The ATRS will cost $15,000 to $20,000, versus the $30,000 and up that wheelchair users now pay to convert vehicles. The figures do not include the cost of the wheelchair or vehicle.

Spletzer and Tom Panzarella, CEO of Cook Technologies, parent company of Freedom Lift Corp., say the ATRS should be a boon to the six million people who, according to the U.S. Bureau of Transportation, have difficulty finding transportation.

“This is a major contributor to the unemployment rate of the disabled population nationally, which is estimated at over 65 percent by the U.S. Census Bureau,” Spletzer and Panzarella wrote in a report.

How it works

The ATRS contains three key components: an articulated power seat that extends outside the vehicle to facilitate wheelchair-to-seat transfers, a power lift platform, and a “smart” wheelchair system.

The ATRS works in the following manner:

You move your powered wheelchair next to the driver’s side of your vehicle. Using a remote-control device similar to a key fob, you open the vehicle door and direct the vehicle to lower the driver’s seat alongside your wheelchair. You then slide over from your wheelchair into the driver’s seat. Once in the driver’s seat, you deploy the power lift platform from the rear of the vehicle through the touch of a button.

Using a joystick for remote control, you then guide your empty wheelchair to the rear of the van. There, the chair is switched to autonomous mode, and drives itself onto the lift platform using position feedback from an integrated laser system at a rate of 10 times per second. The lift platform then raises and stows the chair in the back of the van.

At this point, you press another button to raise the driver’s seat, in which you are sitting, up into the van. The driver’s seat is then restored to its normal driving position and secured.

When you arrive at your destination, you reverse the entire procedure.

Spletzer, who directs Lehigh’s Vision, Autonomous Devices, and Experimental Robotics (VADER) Laboratory, says the ATRS represents a cutting-edge application of mobile robotics.

“There have been many advances in mobile robotics in recent years,” says Spletzer, who has worked two years with Freedom Sciences on the ATRS. “But most of these outdoor applications are in mining and other environments where people are excluded by design. The ATRS, on the other hand, is designed to assist humans and to be used with their direction. We believe it has the potential to become one of the most widespread outdoor applications of commercial robotics to date.”

The ATRS contains several other features that add value while enhancing reliability and safety, says Spletzer.

* The laser system on the rear lift platform takes corrective action if an obstruction or slick spot causes the wheelchair to veer off course as it moves toward the platform.

“The laser system is constantly monitoring itself,” says Spletzer. “If it is not 99.9 percent sure that the docking will be successful, it will back the chair up and perform corrective action.”

* A camera above the platform lift, working in tandem with a human-robot user-interface computer on the ATRS dashboard, lets the driver know when to use the joystick to close the rear hatch of the ATRS-equipped vehicle.

* Once the chair has been stowed, two hooks on the rear platform grip a plow bar on the chair and lock it in place.

“In the event of a vehicle accident or collision, the locking mechanism prevents the chair from becoming a dangerous projectile inside the vehicle,” says Spletzer.

* To help drivers move from wheelchair to car seat, the ATRS Freedom Seat is fully articulated. Its adjustable height allows drivers to always move down when they slide from wheelchair to car seat or vice versa.

* The system’s modularity enables the ATRS to accommodate almost all sizes and models of wheelchairs and to offer easy upgrades for wheelchair users who have progressive diseases.

Next year, says Spletzer, Freedom Sciences is planning to develop an advanced ATRS for wheelchair users who have difficulty sliding themselves from the chair to the car seat. The new system will be fully automated, using a small “smart” camera instead of a joystick.

The modifications required to make a wheelchair ATRS-compatible are invisible, says Spletzer, as the computing, gyroscope and encoders that are added to the chair are transparent to the user. “In normal day to day use,” he says, “it is no different from a standard power chair.”

The ATRS is going to market at an opportune time, say Spletzer and Panzarella.

The expected increase in the population of Americans aged 65 and over will no doubt cause a corresponding rise in the number of wheelchair users, they say.

“We’ve already received a number of e-mails from people who say the ATRS will really help them in their daily lives,” says Spletzer.

Spletzer developed the algorithms, or sets of rules, for autonomous navigation of the ATRS. These were first validated in simulation using MATLAB, a technical computing language, before being ported to the actual hardware.

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Contact: Kurt Pfitzer

Lehigh University

Medicare beneficiaries who need physical therapist services would find it easier and more efficient to obtain treatment under legislation introduced yesterday in the US House of Representatives. The Medicare Patient Access to Physical Therapists Act (HR 1829), introduced by Representatives Earl Pomeroy (D-ND), Tim Murphy (R-PA), and Tammy Baldwin (D-WI), eliminates the need for beneficiaries to obtain a physician referral for physical therapy services.

“Direct access under Medicare would remove unnecessary barriers to the cost-effective rehabilitation services provided by physical therapists,” said APTA President R Scott Ward, PT, PhD. “Currently these health care consumers, which include seniors and people with disabilities, often have the greatest need for physical therapy services and experience unnecessary burdens to access these services. The referral process can often cause delays that can impede a patient’s ability to achieve his or her optimal functional outcome. In light of today’s economic environment, timely access to cost-effective physical therapy services for Medicare beneficiaries is critical.”

Forty-eight states and the District of Columbia have eliminated the physician referral requirement for patients to access physical therapists for an evaluation, while 44 states and DC allow access to some form of physical therapy treatment without referral. This legislation would defer to the state law on access regarding physical therapy.

“Requiring Medicare patients to get a physician referral before they can see a physical therapist puts an undue burden on residents of rural areas who often travel long distances just to see their doctor,” Representative Pomeroy said. “Removing the physician referral requirement would save valuable time and money for Medicare patients in North Dakota and across the country.”

Representative Murphy added, “Eliminating barriers to patient choice has been an ongoing effort of mine both in the Pennsylvania State Senate and now in Congress. The Medicare Patient Access to Physical Therapists Act eliminates the burden of unnecessary visits to physicians for patients to access physical therapy care. Delaying this care not only results in higher costs but unnecessary pain and frustration from patients. Right now, the United States Department of Defense allows licensed physical therapists to act as primary care providers for military personnel and their dependents without an initial physician referral. We should extend this option to Medicare patients, and this bill does just that.”

“Health care delivery must be a collaborative and cooperative effort,” said Representative Baldwin. “This legislation acknowledges the important roles of physical therapists in patient care and of individual states in influencing health care policy. As we strive to improve the quality of care, increase accessibility, and lower costs, allowing states to give Medicare patients direct access to physical therapists is one piece of the solution. I’m proud to co-sponsor HR 1829 and will work hard to see it included in our health care reform package this year.”

A Senate companion bill is expected to be introduced in the next several weeks.

Physical therapists are highly-educated, licensed health care professionals who can help patients reduce pain and improve or restore mobility – in many cases without expensive surgery or the side effects of prescription medications. APTA represents more than 70,000 physical therapists, physical therapist assistants, and students of physical therapy nationwide. Its purpose is to improve the health and quality of life of individuals through the advancement of physical therapist practice. In most states, patients can make an appointment directly with a physical therapist, without a physician referral. Learn more about conditions physical therapists can treat and find a physical therapist in your area at moveforwardpt.

American Physical Therapy Association
apta

Naidex ’09, the UK’s leading disability, homecare and rehabilitation show (28th-30th April, NEC, Birmingham) is delighted to announce that it will be hosting a full programme of pressure care seminars presented by well known seating specialist Fiona Collins.

The seminars will take place in the Professional Seminar Theatre (stand G20) on all three days of the event and will allow healthcare professionals and members of the public to increase their knowledge and understanding of the principles of seating theory, as well as explore practical specialist seating solutions within a care environment.

1.2 million people in the UK suffer from painful pressure sores that arise from prolonged periods of sitting. Most pressure care specialists will agree that prevention is better than cure and competent nursing care should result in pressure damage being avoided. The seminars will present case studies to examine therapists’ accountability as well as cover topics including: Dynamic Seating for Personal Hygiene, Seating Assessment, Seating the Bariatric Patient and Gaining Funding for Seating. Healthcare professionals will also receive a certificate of attendance for inclusion in their CPD portfolio.

Event Manager, Liz Virgo commented, “It is our aim to make Naidex as enjoyable and informative as possible, and a worthwhile day out for both healthcare professionals and members of the public. The pressure care seminars provide the perfect opportunity for anyone interested in this important issue to get the latest tips and advice from the specialists.”

As well as learning about pressure care management, visitors will also be able to test and compare the latest specialist seating products from reputable companies exhibiting at the show including Kirton Healthcare, Minivator and Nottingham Rehab Supplies.

Naidex ’09 promises to be a rich and rewarding experience with over 350 exhibitors, thousands of products and new show features. Last year over 10,000 visitors attended the show and this year promises to be the most exciting Naidex event yet.

For further information on visiting the show, and to pre-register for free entry please visit naidex

Source
Naidex

People who receive higher disability ratings for work-related back injuries don’t necessarily fare worse over the long term than those who get lower ratings, a Saint Louis University study finds.

The study, which reinforced previous research showing blacks receive less treatment for their back pain than whites, was published online this month in the Journal of Pain. The new research is among the first to examine the relationship between Workers’ Compensation settlements for back pain and long-term functional outcomes.

“A disability rating is supposed to reflect the amount of impairment a person has at the time that a case is closed. The presumption is that levels of impairment are stable and related to day-to-day levels of function. I was shocked that the associations between disability rating and subsequent levels of function weren’t stronger,” said Raymond Tait, Ph.D., professor of psychiatry at Saint Louis University School of Medicine.

Disability ratings also differed between African-Americans and Caucasians. According to Tait, those differences probably reflected differences in treatment: whites were four times more likely to have surgery than blacks. Thos who had surgery received larger settlements for their injuries, Tait said.

“While surgery inflated disability ratings, there appeared not relationship between surgery outcomes and how a person did thereafter,” he said.

Tait and colleague John Chibnall, Ph.D., also a professor of psychiatry at Saint Lois University, looked at about 1,500 Missouri workers – 580 African-Americans and 892 Caucasians – whose Workers’ Compensation claims for lower back pain were settled between Jan. 1, 2001 and June 1, 2002.

Researchers interviewed the employees 21 months after their settlements about how they were doing. They asked questions about pain intensity, general physical and mental health and whether they currently were working.

Tait and Chibnall said that their findings “raise questions about both the validity and the fairness of the current disability determination program. Disability settlements are designed to give people money toward a fresh start. Those settlements do not appear to reflect the residual levels of disability that people actually experience.”

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Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: cancer, liver disease, heart/lung disease, aging and brain disease, and infectious disease.

Contact: Nancy Solomon

Saint Louis University

Those suffering from chronic obstructive pulmonary disease (COPD) often complain that exercise is too exhausting and leaves them breathless. An article in the current issue of The New England Journal of Medicine reports that supervised exercise through pulmonary rehabilitation can actually reduce their feelings of breathlessness, increase their tolerance for exercise and improve their quality of life.

The article’s lead author is Richard Casaburi, Ph.D., M.D., a senior investigator at the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (LA BioMed). He directs the institute’s Rehabilitation Clinical Trials Center, a facility that focuses on COPD research. Dr. Casaburi surveyed previous studies on pulmonary rehabilitation for COPD and found that supervised exercise therapy improves aerobic function of the muscles, which helps reduce the breathlessness that is common in COPD.

“These findings are a clear indication that pulmonary rehabilitation can improve the quality of life for those living with COPD,” said Dr. Casaburi. “The studies also indicate that pulmonary rehabilitation results in decreased anxiety and depression for COPD patients because they find they can exercise more, and they enjoy the feeling that they have mastered something important in their lives.”

COPD, a group of lung diseases that includes chronic bronchitis and emphysema, is the fourth leading cause of death in the United States. The article in the Journal reports that it is on course to be the third most common cause of death worldwide by 2020.

Once a disease primarily of men, it now kills roughly equal numbers of men and women in the U.S. In 2000, COPD was responsible for 8 million physician office visits, 1.5 million emergency department visits and 726,000 hospitalizations (about 13% of all hospitalizations in the U.S.).

While the benefits of pulmonary rehabilitation programs for COPD are well-documented, the Journal article reports that access to this type of therapy is limited, especially among lower-income, minority and rural populations.

“A major stumbling block in providing pulmonary rehabilitation for COPD has been the lack of adequate funding for it,” said Dr. Casaburi. “That should begin to change next January, when Medicare starts providing coverage for pulmonary rehabilitation for COPD.”

About LA BioMed

Founded 56 years ago, LA BioMed is one of the country’s largest not-for-profit independent biomedical research institutes. It conducts biomedical research, trains young scientists and provides community services, including childhood immunization and nutrition assistance. The institute’s researchers conduct studies in such areas as cardio-vascular disease, emerging infections, cancer, diabetes, kidney disease, dermatology, reproductive health, vaccine development, respiratory disorders, inherited illnesses and neonatology.

LA BioMed is an independent institute that is academically affiliated with the David Geffen School of Medicine at UCLA. The institute is located on the campus of Harbor-UCLA Medical Center near Torrance.

Source
LA BioMed

The Wall Street Journal on Monday examined how many brain injury patients who experience subsequent problems with memory, mental processing or behavior often do not receive cognitive rehabilitation because their health insurers do not cover the treatment. According to the Journal, cognitive rehabilitation seeks to “reteach injured parts of the brain how to perform basic functions, like organizing the day or tuning out distractions,” through the use of card games and computer programs, as well as memory aides, such as stickers, timers, notebooks and handheld recorders. Preliminary studies indicate the effectiveness of cognitive rehabilitation, but research into the treatment remains limited because of a lack of funding by pharmaceutical companies. A committee established by NIH in 1998 to evaluate cognitive rehabilitation concluded that the “evidence supports the use of certain cognitive and behavioral rehabilitation strategies” as part of a structured plan. In addition, an analysis of 87 studies published in the Archives of Physical Medicine and Rehabilitation in 2006 found “substantial evidence to support cognitive rehabilitation for people with traumatic brain injury.” However, many health insurers maintain that research to support the effectiveness of cognitive rehabilitation remains insufficient. In 2002, the BlueCross BlueShield Association Technology Evaluation Center said, “Available data are considered insufficient to make conclusions on whether cognitive rehabilitation results in beneficial health outcomes.” WellPoint covers cognitive rehabilitation for patients involved in accidents but not for those who experience strokes. Thomas Watanabe, a professor of physical medicine and rehabilitation, said, “It’s hard to demonstrate cognitive progress to the insurance company,” adding, “If a patient starts out in a wheelchair and then starts walking with a cane, you can measure that progress” (Burton, Wall Street Journal, 1/8).

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Inmates from Washington state prisons in the US are 13 times more likely to die within the first two weeks of their release than other people of similar age,
sex and race. The most likely cause of death at this vulnerable period of a former inmate’s life is drug overdose, followed by suicide, heart disease, and
homicide.

This research is published in the latest edition of the New England Journal of Medicine.

The study was led by Dr. Ingrid Binswanger of the Department of Medicine, Division of General Internal Medicine, University of Colorado at Denver, and the
team included Dr. Marc Stern of the Washington State Department of Corrections, and other scientists from Seattle.

The scientists conducted a retrospective cohort study on 30,237 former inmates who left prison in the period July 1999 to December 2003. They used data from
prison records and linked it to the National Death Index. They compared the figures with those on Washington State residents, using data from the large
epidemiological databases at the Centers for Disease Control and Prevention.

The results showed that 443 of the former inmates had died during a mean follow-up period of 1.9 years after release, equivalent to an overall mortality rate of 777
deaths per 100,000 person-years. This yielded an adjusted risk of death of 3.5 times higher than that of state residents of similar age, race and sex. This
risk rose to 12.7 times for the first 2 weeks of release, with drug overdose being markedly significant as the main risk of death during this period.

The researchers suggest that the reasons for the high death rates could be linked with an existing mental illness coupled with the stress of adapting to a
life in society (“re-entry stress”).

Dr. Binswanger says that if these results are replicated in other states, the implications would be “staggering”. She suggests this may well point to a need
for boosting support for former inmates while they adapt to life outside prison, for example by increasing availability of half-way houses and drug
rehabilitation.

The study was prompted by a concern for the large and growing number of former prisoners in the US population and the recognition that the period following
release may present them with substantial health risks.

According to the Commission on Safety and Abuse in America’s Prisons (CSAAP), on any given day there are 2.2 million people in prison in the US (about 1 in
140 of the population), at an annual cost of 60 billion dollars a year.

“Release from Prison – A High Risk of Death for Former Inmates.”
Ingrid A. Binswanger, M.D., Marc F. Stern, M.D., Richard A. Deyo, M.D., Patrick J. Heagerty, Ph.D., Allen Cheadle, Ph.D., Joann G. Elmore, M.D., and Thomas
D. Koepsell, M.D.
NEJM Volume 356:157-165, January 11, 2007, Number 2

Commission on Safety and Abuse in America’s Prisons

: Catharine Paddock
Writer: blog

Tredegar based Mountway, one of the UK’s leading manufacturers and suppliers of independent living solutions, has recently gained an exciting new customer for its Aquila bath lift, the respected Professor Stephen Hawking, CBE. Professor Hawking’s scientific career spans over 40 years and his books and public appearances have made him an academic celebrity and world-renowned theoretical physicist.

Author of bestseller, ‘A Brief History of Time’, Professor Hawking purchased one of Mountway’s most popular products, the Aquila reclining bath lift, specifically for use while travelling. At just 9.6 kg, the Aquila is one of the lightest reclining bath lifts available on the market.

The Aquila has a backrest that reclines at the touch of a button and is particularly suited to users whose specific conditions may benefit from opening the seat-to-back angle. The robust and compact Aquila offers an array of optional accessories, making it flexible for use by both adults and children, and is also suitable for a wide variety of bath styles. With its lightweight, flat folding design, the Aquila is easy to move and handle and can separate into two sections for space-saving storage and easy transportability.

Hygienic and simple to clean, the Aquila also features a silver-based antimicrobial solution that protects against harmful bacteria and bathroom mould, ensuring maximum cleanliness.

Genevieve Hamlett, Professor Hawking’s Care Manager commented, “The bath lift we had before was terribly heavy and very awkward. With the Aquila I can pack it in his suitcase, whereas the previous bath lift had to go separately on the plane and ended up breaking! Both the Aquila and the customer service from Mountway have been absolutely fantastic.”

Since introducing the revolutionary Aquajac bath lift in 1981, Mountway’s high quality, design led product portfolio has been extended to its current range which provides exceptional assistive technology solutions encompassing – bathing, toileting, bedroom, transfer aids, daily living aids and mobility products. Mountway’s core products include the Neptune and Aquila Bath Lifts, Mountway Solo Toilet Lift, Serena Pillow Lift and the Etac Clean and Etac Swift shower/commode chairs. Full product details are available at mountway

Mountway Limited

At the heart of Mountway’s philosophy is the ethos ‘Bringing independence to life’ and as a family-owned company, Mountway prides itself on its caring culture. The R&D, marketing and customer service departments endeavour to listen intently both to the needs of customers and to feedback from healthcare professionals at all times, and this customer-focused approach has resulted in the company’s well-established and respected reputation for the manufacture and distribution of a range of innovative, high-quality independent living solutions.

Source
Mountway Limited

It has been announced that as of 1st March 2009, the FHT Ireland, which operated as an independent association has been incorporated into the UK based Federation of Holistic Therapists. The decision has been taken following consultation and the obvious benefits to Irish therapists that result.

Irish therapists can take advantage of the enhanced membership services that the FHT provide and a greater support network than ever before. They will benefit from increased awareness, as the FHT is the leading association for complementary therapists proactively bringing the industry to the top of the political agenda, as well as into the homes of the general public.

As the largest complementary therapy organisation in the UK, with nearly 20,000 members, Ireland’s therapists will receive considerable cost savings as a result. Membership fees have been reduced (Annual FHT Ireland membership is now only ВЈ80) while member benefits will improve.
Carina Fagan, Vice President of the FHT, will continue in her role to support FHT activities in Ireland, commenting upon the change she says,

“This is a great opportunity for Ireland’s therapists to make a real impact, as we are now part of a much larger organisation representing the same cause. The FHT has been working for many years in the political and education arenas to raise the status of member therapists. As result, standards of practice have improved and we are taken much more seriously as an industry which is something that Irish therapists really want to be part of.

I will continue to represent Irish therapists but as part of the FHT Governing Council I can work more proactively, representing the interests of Irish professional practitioners and supporting the FHT activities in Ireland.”

As a result of the changes all administrative operations will be carried out from the FHT’s head office in Eastleigh, however the FHT Ireland Helpline (016771076) will remain the same with no increase in call charges.

Chief Executive of the FHT in the UK, John French believes it is a move that will benefit all,
“We are pleased to be working on behalf of therapists in Ireland and will continue with our work to improve the status of our industry. We have established a strong network of influential supporters throughout the UK that has resulted in our industry gaining coverage and respect with politicians, health practitioners, the media and the general public. Therapists in Ireland will benefit from this increased profile, as well as receiving cost savings and access to the many training courses that we run.”

For further details on the FHT on 0844 875 2022 or visit the FHT website at fht

Source
FHT

Our goal is to develop a surgical treatment that will improve vision for patients with agerelated macular degeneration (AMD). AMD is the most common cause of blindness among people over age 55 in the United States (including veterans). In most AMD patients with severe visual loss, abnormal blood vessels grow under the central retina (the area that provides high resolution vision) and cause bleeding, scarring, and blindness. If surgical excision of the abnormal vessels can be combined with resurfacing of the dissection area by the patient’s own retinal pigment epithelial cells (RPE), then vision might be restored postoperatively. We studied the ability of young versus old RPE cells to grow in cell culture on surfaces that contain proteins believed to foster RPE migration and proliferation. We found that old as well as young RPE cells can grow in cell culture on surfaces that contain appropriate extracellular matrix ligands. These results will guide us in developing techniques to provide sight-restoring treatment for patients with exudative AMD.

Status of the feline retina 5 years after subretinal implantation, pg. 723

The long-term biocompatibility and durability of retinal prosthetics are essential components of a viable clinical device. In this study, we report results obtained 5 years following implantation of normal adult cats with a subretinal microphotodiode array. All implants functioned throughout the study period. Small changes in retinal function and morphology were noted that could be attributed to surgical manipulation or the presence of a solid device in the subretinal space. No indications of rejection of the prosthesis existed. Clinical trials to determine whether visual improvements exist in patients implanted with subretinal devices of similar design are in progress, while animal studies address the mechanisms that may underlie these improvements.

Nonmydriatic teleretinal imaging improves adherence to annual eye examinations in patients with diabetes, pg. 733

We studied whether teleretinal imaging during a primary care provider visit would increase the chances that patients with diabetes obtained a follow-up dilated eye examination. We measured the number of patients who received dilated eye examinations within 12 months of study enrollment and measured the agreement on level of diabetic retinopathy between teleretinal imaging and the eye examinations. Patients who had received teleretinal imaging (n = 223) had significantly more dilated eye examinations than the control group (n = 225). Teleretinal imaging and eye examination results showed significant correlation and moderate agreement. Patients reported a high degree of satisfaction with teleretinal imaging. The imaging also improved diabetic retinopathy assessment rates.

Framework for a national teleretinal imaging program to screen for diabetic retinopathy in Veterans Health Administration patients, pg. 741

Digital retinal imaging with remote image interpretation (teleretinal imaging) is an emerging healthcare technology for screening patients for diabetic retinopathy (DR). An expert panel met to identify and solve the issues related to use of teleretinal imaging in the Veterans Health Administration (VHA). The panel made recommendations and identified areas that required more information. These recommendations became the framework for a national teleretinal imaging program. Subsequent VHA experience with teleretinal imaging and accumulating scientific evidence support nationwide use of teleretinal imaging to screen for DR. The program will increase patients’ access to screening and uniquely evaluate the role of teleretinal imaging in the care of patients with diabetes.

Retinal locus for scanning text, pg. 749

We developed and tested a method of mapping the retinal location of text scanning during reading. Text location is plotted cumulatively on scanning laser ophthalmoscope (SLO) retinal images. Retinal locations that contain text most often are brightest in the cumulative plot, and locations that contain text least often are darkest. Text maps of five subjects with scotomas from macular degeneration showed that they used the same peripheral retinal area to scan text and fixate. Text maps of three subjects with scotomas showed that they used separate areas to scan text and fixate. Retinal text maps may help evaluate strategies that train people with scotomas to use a particular retinal area to scan text.

Effects of preferred retinal locus placement on text navigation and development of advantageous trained retinal locus, pg. 761

We sought to identify factors that inhibit the reading ability of veterans with visual impairments. Our study investigated whether preferred retinal locus (PRL) and scotoma placement were related to text navigation ability in subjects with low vision. We also investigated whether a trained retinal loci (TRL) could be developed in the better-seeing eyes of subjects with low vision who were long-term PRL users. We evaluated 60 subjects’ visual function and text-navigation abilities. The visual field and PRL were measured with a scanning laser ophthalmoscope (SLO). We found significant differences in text-navigation ability based on scotoma and PRL placement. In a follow-up study, seven subjects with a nonadvantageous PRL quickly developed a TRL during instruction with an SLO. Our study results may inform clinical practice, increase veterans’ reading abilities, and stimulate new research on this topic.

Recognition distance of pedestrian traffic signals by individuals with low vision, pg. 771

Researchers have developed a variety of accessible pedestrian signals (APS) to facilitate safe street-crossing for visually impaired individuals. Forty-one subjects with vision loss participated in our study to determine the minimum distance they required to correctly identify three different pedestrian traffic icon symbols. We performed a replication of an earlier study to measure differences in the relative conspicuousness of APS presented in a community environment. We found that subjects identified the WALK icon without augmented light source information (animated eyes) from farther away than either the WALK icon with augmented light source information or the DON’T WALK icon. This result suggests that changes to the pedestrian display must be evaluated for various types of eye conditions that cause low vision. We wanted to provide vision rehabilitation professionals, as well as transportation and traffic safety engineers, with reliable, valid, and scientifically collected data for assessment of these APS.

Longitudinal associations between dual sensory impairment and everyday competence among older adults, pg. 777

Dual sensory impairment in hearing and vision currently affects from 5 to 21 percent of older adults. Using Longitudinal Study on Aging (LSOA) data, we examined the associations between self-reported dual impairment and everyday competence in terms of self-reported activities of daily living (ADL) among adults aged 70 and older. We found an overall trend of increasing difficulty reported for ADL tasks; those reporting no difficulty decreased from approximately two-thirds to one-half over the 6 years of the LSOA. Findings highlight the importance of vision and aural rehabilitation programs for older adults to mitigate the loss of competence in later life due to sensory impairment.

Historical perspective on the development of outcomes measures for low vision and blind rehabilitation in the Department of Veterans Affairs, pg. 793

This article reviews the instrument development process and summarizes current research findings for three low-vision and blind rehabilitation outcomes measures developed in the Department of Veterans Affairs (VA). The measures examined include the Blind Rehabilitation Service Functional Outcomes Survey, the Functional Assessment of Self-Reliance on Tasks, and the VA Low Vision Visual Functioning Questionnaire. We compared and contrasted the instrument development process and research findings for the three measures using two fundamental measurement criteria. Our findings suggest the three measures need refinement to meet the criteria and proposed measurement standards for instruments in this field. We hope that future development efforts both within and outside the VA will incorporate these criteria. The development of instruments that meet the specified measurement standards and demonstrate clinical relevance is an essential step toward establishing an evidence-based system for the VA and the field of low-vision and blind rehabilitation.

Timing and directions for administration of questionnaires affect outcomes measurement, pg. 809

We compared data from pilot studies involving patients’ self-reported health-related quality of life after participation in two Department of Veterans Affairs (VA) Blind Rehabilitation Center (BRC) programs. Southwestern BRC researchers in Tucson, Arizona, administered the National Eye Institute Visual Functioning Questionnaire (NEI VFQ) exactly as directed, while researchers at the VA hospital BRC in Hines, Illinois, modified the directions to consider use of low-vision devices. Person and item measures estimated from the patient’s pre- and postrehabilitation responses were compared with these same measures obtained at follow-up. At the Southwestern BRC, no change was reported in either person or item measures 3 months after rehabilitation. At the Hines BRC, improvement was seen in both the person and item measures when measurements were made immediately following rehabilitation. Veterans from the Hines cohort were contacted by telephone and administered the same instrument 3 years later. For these subjects, the improvement noted in the person measure disappeared at follow-up, while the improvement in the item measure was maintained. If outcomes are measured before patients have time to use their low-vision devices and skills at home, halo effects may modify outcomes measurement. We recommend that researchers using the NEI VFQ modify the questions to make the instrument more sensitive to improvements that occur after treatment.

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About the Journal: JRRD has been a leading research journal in the field of rehabilitation medicine and technology for more than 40 years. JRRD, a peer-reviewed, scientifically indexed journal, publishes original research papers from U.S. and international researchers on all rehabilitation disciplines. JRRD’s mission is to responsibly evaluate and disseminate scientific research findings to the rehabilitative healthcare community.

Contact: Dore Mobley

Journal of Rehabilitation Research