Enhancing health and independent living for veterans with disabilities by leveraging community-based resources.

The number of US veterans with disabilities has increased in recent years as service members have returned home with extensive injuries and veterans from previous wars acquire functional limitations as a consequence of aging with chronic diseases. Veterans with severe disabilities need assistance and support to maintain independence at home and to avoid institutionalization. The US Department of Veterans Affairs (VA) strives to network with community organizations to achieve the best possible outcomes for veterans. Key community resources in the US for individuals with disabilities are Centers for Independent Living (CILs) that provide a wide range of services, promoting independent living and well-being for people across disabilities. The widespread availability and services of CILs nationwide suggest their potential as a community-based resource for veterans, particularly for those with limited access to VA care. In this article, we discuss long-term needs of veterans with disabilities, efforts to address veterans' rehabilitation needs at the VA and opportunities for leveraging the strengths of community-based organizations for veterans. More research is warranted to investigate CIL services and potential for CIL-VA partnerships.

The impact of war on Puerto Rican families: challenges and strengthened family relationships.

We describe the impact of war on Puerto Rican Veterans and family members. We used qualitative research methods to collect and analyze data. We interviewed 8 Veterans and 8 family members. We used the constant comparison method to review data to identify prominent themes. Two categories emerged: (1) Challenges associated with post-deployment family reintegration, and (2) A positive aftermath of war on the family. Overall, findings indicate that OEF/OIF Veterans and family members were not prepared for the changes they encounter post-deployment. Despite these challenges, some Veterans and family members strengthened their relationships and renewed their appreciation for one another.

Exploratory pilot study of driving perceptions among OIF/OEF Veterans with mTBI and PTSD.

Veterans of Iraq and Afghanistan may experience driving-related challenges postdeployment, including more at-fault crashes. Causes may include defensive driving tactics learned for combat zones and consequences of traumatic brain injuries (TBIs) and posttraumatic stress disorder (PTSD). Tailoring driver interventions to meet Veterans' needs requires an understanding of their driving perceptions. We explored the driving perceptions of five combat Veterans (4 men, 1 woman) with mild TBI and PTSD using grounded theory methods. Veterans participated in single, semistructured interviews during a comprehensive driving evaluation. Interviews were digitally recorded, transcribed verbatim, verified, and imported into NVivo 8 software for coding and analysis. Veterans were insightful about driving and identified specific environmental triggers for anxious driving, speeding, and road rage. Veterans used strategies to moderate driving behaviors, but continued to drive aggressively. Themes were used to develop a conceptual framework of driving postdeployment, laying the foundation for intervention studies.

Florida mammographer disability training vs needs.

BACKGROUND: There is currently no minimum required competency for mammographers regarding imaging patients with physical disabilities. Yet, as disability prevalence rates increase, mammographers interact with more women with disabilities at breast imaging facilities. PURPOSE: To better understand the disability training that mammographers receive and desire, and the advice they would extend to colleagues regarding improving the experience when performing mammography on women with disabilities. METHODS: Within the context of a community and academic partnership, in-depth telephone interviews were conducted with 14 mammographers practicing in north central Florida. Grounded theory techniques facilitated analysis for major themes. RESULTS: The extent, content, and delivery of disability training varied among participants. Analysis revealed respondents' personal desires for training focused on positioning to "get the best breast image," while mammographers' advice to colleagues focused on the need to afford patience and respect to the patient. Four identified themes included learning on the job, asking for help, desired training to acquire the best possible image, and advice to other mammographers regarding patience. CONCLUSION: Mammographers value the disability training they receive as a foundation for continued learning on the job. Training should comprise both technical and social aspects of performing mammography on women with disabilities, including positioning, disability etiquette, and disability advocacy.

Unmet health services needs experienced by Puerto Rican OEF/OIF veterans and families post deployment.

OBJECTIVE: This study examined perceptions of unmet health services needs among native Puerto Rican Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) Veterans and family members (FMs) post deployment. METHODS: Investigators used qualitative methods to collect and analyze data from 8 veterans and 8 FMs (N = 16). All participants were native-born residents of Puerto Rico. Investigators conducted single, in-depth interviews with participants. They conducted 13/16 interviews in Spanish. Puerto Rican-Spanish speakers transcribed audio-taped interviews verbatim and then translated them into English for coding. RESULTS: Veterans' unmet needs included psychological evaluations, mental health services, support groups, medical evaluations, and pain treatment. Denial and stigma emerged as factors that deter Veterans from seeking mental health treatment. The need for family support groups also emerged from the data. CONCLUSIONS: Native Puerto Rican Veterans and FMs identified several gaps in health services. Findings suggest the need for studies comparing the health services needs of Puerto Rican versus mainland OEF/OIF Veterans and families.

Beyond gait speed: a case report of a multidimensional approach to locomotor rehabilitation outcomes in incomplete spinal cord injury.

BACKGROUND: The efficacy of locomotor rehabilitation studies has largely been based on clinical measures of gait speed and walking performance. Although critical, gait speed does not fully capture the multidimensional benefits associated with walking recovery. The International Classification of Function, Disability and Health (ICF) model of rehabilitation emphasizes the role of personal and environmental factors in affecting quality of life and personal health status and advocates a broad approach in the assessment and treatment of people with disabling conditions. OBJECTIVE: The purpose of this case report is to describe a multidimensional approach to outcome measurement reflecting the ICF model. SUBJECT: The participant was a 59-year-old man with C7 American Spinal Injury Association impairment D tetraplegia, 16 months after injury. INTERVENTION: The participant completed a 45-session, five days per week locomotor training program. Comprehensive evaluations were completed pre- and post-training targeting all elements of the ICF model. OUTCOMES: The participant achieved negligible increases in gait speed, but increased self-elected walking activity from 26 steps per day to 1273 steps per day. His assistive device changed from a platform to a rolling walker, representing a Walking Index for Spinal Cord Injury (WISCI) increase from 8/20 to 13/20. Qualitative interviews illustrated an attitudinal shift, leading to improved motivation, confidence, self-esteem, problem-solving, and increased activities/participation in the community. Ultimately, the participant was able to transition from nursing home placement to living independently. CONCLUSIONS: This case report emphasizes the need to move beyond traditional models for evaluation at the impairment and clinical level to examine the effects of interventions on independence, community integration, and quality of life.

Locomotor training: experiencing the changing body.

This study examined the experiences of persons with incomplete spinal cord injury who participated in loco-motor training (LT). LT is an emerging rehabilitation intervention for enhancing the recovery of walking in persons with central nervous system disorders. Multiple interviews and field observations provided data from eight participants, including four veterans. Findings indicate that experiences of bodily changes were prevalent among participants. Themes included (1) experiencing impaired or absent proprioception, (2) struggling for bodily control, and (3) experiencing emergent bodily sensations. Themes 1 and 2 reflected bodily disruption as a result of spinal cord injury and were challenging to participants as they attempted to reconnect the body and self through LT. Theme 3 reflected bodily sensations (burning, soreness) that were seen as positive signs of recovery and resulted in hope and motivation. Understanding how LT participants experience bodily changes may enable therapists to develop improved participant-centered intervention approaches.

Locomotor training progression and outcomes after incomplete spinal cord injury.

BACKGROUND AND PURPOSE: The use of locomotor training with a body-weight-support system and treadmill (BWST) and manual assistance has increased in rehabilitation. The purpose of this case report is to describe the process for retraining walking in a person with an incomplete spinal cord injury (SCI) using the BWST and transferring skills from the BWST to overground assessment and community ambulation. CASE DESCRIPTION: Following discharge from rehabilitation, a man with an incomplete SCI at C5-6 and an American Spinal Injury Association (ASIA) Impairment Scale classification of D participated in 45 sessions of locomotor training. OUTCOMES: Walking speed and independence improved from 0.19 m/s as a home ambulator using a rolling walker and a right ankle-foot orthosis to 1.01 m/s as a full-time ambulator using a cane only for community mobility. Walking activity (mean+/-SD) per 24 hours increased from 1,054+/-543 steps to 3,924+/-1,629 steps. DISCUSSION: In a person with an incomplete SCI, walking ability improved after locomotor training that used a decision-making algorithm and progression across training environments.