Exploring perspectives on assistive technology use: barriers, facilitators, and access.

PURPOSE: This qualitative study explored perceived barriers and facilitators to access and utilization of assistive technology (AT) among Veterans and civilians living with tetraplegia. We also explored differences in access to and utilization of AT between civilians and Veterans. MATERIALS AND METHODS: Semi-structured focus groups were conducted with 32 adults (15 Veterans, 17 non-Veterans) living with tetraplegia between the ages of 18 and 65 and who were at least one-year post-injury. Focus groups were conducted at two rehabilitation sites: Craig Hospital and the Louis Stokes Cleveland VA Medical Center. Participants were asked to discuss what they perceive as (1) the facilitators and barriers of AT access and utilization, and (2) the value of AT use in everyday living. Data were analyzed using thematic analysis of verbatim transcripts. RESULTS AND CONCLUSIONS: Facilitators of AT utilization and access included being connected to resources, trial-and-error, and knowledge gained from peers. Barriers to AT use included cost of devices, a general lack of awareness of resources, and requirements for eligibility; the latter two themes were endorsed solely by Veteran participants. Benefits of AT included increased independence, participation, productivity, quality of life, and safety. Findings highlight key facilitators of AT procurement and use, barriers that contribute to underutilization of AT, and important benefits experienced as a result of using AT that underscore the importance of AT for individuals with SCI.

The need to maintain connections with rehabilitation resources (e.g., the Department of Vocational Rehabilitation, occupational and physical therapists, the VA, inpatient facilities) is vital to learning about and procuring AT.There is a need for a tailored approach to address AT underutilization in civilian and Veteran populations.Despite the barriers to AT use and the challenges associated with discovery of AT, utilization of AT may lead to increased independence, participation, productivity, quality of life, and safety.

Going Remote: A Revised Study Protocol for a Pilot Randomized Controlled Trial for Biofeedback Treatment of Anxiety Associated With Chronic Spinal Cord Injury.

Background: The incidence of anxiety in adults with spinal cord injury/disorder (SCI/D) exceeds that of the general population. Heart rate variability (HRV) biofeedback training is a potential treatment associated with a reduction in stress and anxiety, however HRV training has not been explored in the SCI/D population. Objectives: To describe a modified protocol piloting HRV training to reduce anxiety associated with SCI/D and detail the COVID-19-related modifications. Methods: To test the feasibility of the biofeedback treatment, 30 adults with SCI/D will complete this pilot randomized controlled trial. Enrollment started in January 2020, halted in March 2020 due to the COVID-19 pandemic, and resumed in March 2021 with a modified protocol. Protocol modifications are documented using the Framework for Reporting Adaptations and Modifications (FRAME). Participants are allocated to the treatment or control arm and undergo eight sessions of physiological monitoring at home using a commercially available HRV sensor and mobile application, which also delivers biofeedback training for those in the treatment arm. Surveys are administered following each session to capture self-reported stress, anxiety, and mood. The study is approved by the HCA-HealthONE institutional review board and is registered with clinicaltrials.gov (NCT# 03975075). Conclusion: COVID-19 has changed the research landscape, forcing scientists to rethink their study designs to address patient and staff safety in this new context. Our modified protocol accomplished this by moving the treatment setting and delivery out of the clinic and into the home. In doing so, we address patient and staff safety, increase external validity, and reduce participant burden.

The pet project: A qualitative exploration into the experience of pet ownership following spinal cord injury.

STUDY DESIGN: Qualitative study OBJECTIVES: To explore the unique experience of facilitators, barriers, rewards, and challenges related to pet ownership after spinal cord injury (SCI). SETTING: Zoom for Healthcare videoconferencing platform hosted from an American neuro-rehabilitation hospital in Colorado. METHODS: Sixteen individuals with SCI participated in three semi-structured focus groups of 5-6 participants each. Resulting discussions were transcribed and coded using a hybrid approach to thematic analysis. RESULTS: Experiences of pet ownership were categorized by their representativeness of four key themes: facilitators (conditions that make obtaining or maintaining pets easier), barriers (conditions that were prohibitive or that prevented people from having pets), rewards (benefits of pet ownership), and challenges (difficulties associated with pet ownership). Participants cited equipment, tools, and services as the most common facilitator for owning pets after SCI, with environment being the most commonly cited barrier. Companionship, love, and comfort/security were most commonly cited as rewards, while mobility was cited as a primary challenge of pet ownership after SCI. Additionally, two unexpected response themes emerged. Positive outweighs negative included assertions that benefits of having pets were not overshadowed by drawbacks, and Wishlist included desires for training and access to tools to facilitate pet ownership. CONCLUSIONS: Pet ownership is largely unexplored in individuals with SCI. Participants in this study indicated that pet ownership provides many benefits, though it is not without its challenges. Participants also noted the desire for training and resources to make pet ownership more accessible. Further exploration into informing development of those tools is warranted.

Treatments perceived to be helpful for neuropathic pain after traumatic spinal cord injury: A multicenter cross-sectional survey study.

DESIGN: Cross-sectional survey. OBJECTIVE: To evaluate the perceived helpfulness of pharmacological and non-pharmacological interventions and their combinations for neuropathic pain (NeuP) and subcategories of NeuP after spinal cord injury (SCI). SETTING: Six Spinal Cord Injury Model System Centers. METHODS: Three hundred ninety one individuals at least one year post traumatic SCI were enrolled. A telephone survey was conducted to determine the pharmacologic and non-pharmacologic treatments used in the last 12 months for each participant's three worst pains, whether these treatments were "helpful", and if currently used, each treatments' effectiveness. RESULTS: Two hundred twenty participants (56%) reported 354 distinct NeuPs. Pharmacological treatments rated helpful for NeuP were non-tramadol opioids (opioids were helpful for 86% of opioid treated NeuPs), cannabinoids (83%), and anti-epileptics (79%). Non-pharmacological treatments rated helpful for NeuP were massage (76%), body position adjustment (74%), and relaxation therapy (70%). Those who used both opioids and exercise reported greater NeuP treatment helpfulness compared to participants using opioids without exercise (P = 0.03). CONCLUSIONS: Opioids, cannabinoids, and massage were reported more commonly as helpful than treatments recommended as first-line therapies by current clinical practice guidelines (CPGs) for NeuP after SCI (antiepileptics and antidepressants). Individuals with SCI likely value the modulating effects of pharmacological and non-pharmacological treatments on the affective components of pain in addition to the sensory components of pain when appraising treatment helpfulness.

Validation of the Injustice Experience Questionnaire (IEQ) in a spinal cord injury population.

STUDY DESIGN: Retrospective analysis of cross-sectional data. OBJECTIVES: To verify the factor structure of the Injustice Experience Questionnaire (IEQ) using a sample of individuals with spinal cord injury (SCI) and to assess IEQ scale reliability and construct validity using the same population. SETTING: Two SCI rehabilitation sites in the United States. METHODS: Three datasets were combined to conduct this validation study. The sample consisted of 341 adults with SCI who completed the IEQ, measures of psychological distress and pain, and provided sociodemographic and injury-related information. A series of confirmatory factor analyses (CFA) and exploratory factor analyses (EFA) were conducted to verify the two-factor structure of the IEQ, Cronbach's alpha was used to demonstrate scale reliability, and correlations between the IEQ and measures of pain and psychological distress were examined to assess construct validity. RESULTS: Poor model fit was observed for the two-factor structure of the IEQ as well as for the subsequent factor-structures that were explored. The IEQ demonstrated strong scale reliability (α = 0.89) and correlations between the IEQ and measures of pain and psychological distress were in the expected direction, indicating good construct validity. CONCLUSIONS: In this preliminary validation study, we failed to confirm the two-factor structure of the IEQ in a population of individuals with SCI. Though good scale reliability and construct validity were observed, further study is needed to refine the IEQ for use in this population.

Understanding consumer perception of deep-fried battered and breaded coatings.

This study aims to investigate three types of deep-fried battered and breadcrumb coatings (fine, medium, and coarse), each coating varying in breadcrumb size. Instrumental testing using X-ray micro-computerized tomography, texture analysis, and acoustic analysis confirms significant differences between each sample in terms of physical and mechanical properties. Four hedonic and 9 sensory attributes were evaluated by 185 consumers for preference and acceptance (9-point scale and just-about-right-scale). Penalty analysis confirmed significant mean drops within all three samples (p < .05), "coarse" having the most and "medium" having the least. This explains "medium" having the overall highest liking score (6.72) and coarse having significantly lower (5.88). Crispness is an important textural attribute representing freshness and quality of deep-fried coatings. However, penalty analysis shows "coarse" coatings with the highest crispness scores, resulting in the greatest significant mean drop (2.01) and lowest overall liking. A combination of flavor, appearance, and texture-related attributes significantly reduce hedonic score (p < .05). Agglomerative hierarchical cluster analysis confirms three clusters of consumers based on liking for either "coarse," "medium," or "fine." Each of these samples has a significant difference in the microstructure. Chi-square test confirms a significant difference in product quality, purchase intent, and met expectations between samples in each cluster group (p < .05). The findings in this research highlight how differences in microstructure of battered and breaded coatings influence textural properties and consumer preference. This can be applied to a wide battered and breaded goods.

Influence of Ethanol on Emulsions Stabilized by Low Molecular Weight Surfactants.

The effect of ethanol on oil-in-water emulsions stabilized with low molecular weight surfactants was investigated. Oil-in-water emulsions were prepared containing varying percentages of ethanol and sunflower oil, and stabilized with different emulsifiers (Tween 20, Tween 80, and Lecithin). Droplet size, viscosity, density, and interfacial tension measurements were carried out. The droplet size of emulsions stabilized by each of the surfactants studied decreased with the addition of ethanol to the aqueous phase showing a minimum at a concentration of ethanol around 40%. The trend in droplet size is accompanied by a decrease in the interfacial tension between water and oil as the ethanol concentration increases. Viscosity measurements show that the change in viscosity of the final emulsion is the result of the change in viscosity of the continuous phase, as well as the change in solubility of the surfactants due to the addition of ethanol. The density of the continuous phase decreases with the addition of ethanol and it is possible to match the densities of the two phases in order to reduce the effect of creaming/sedimentation and improve stability. This study provides scientific evidence for the formulation of stable emulsions containing a range of ethanol form 0 to 40%. PRACTICAL APPLICATION: Formation and stability of food-grade emulsions in the presence of ethanol.

Understanding and predicting sensory crispness of deep-fried battered and breaded coatings.

Crusted crispness refers to coatings with a dry and brittle surface contrasting a high-moisture core; it is desirable for the enjoyment and quality of deep-fried goods. This study aims to investigate instrumental measurements and sensory measurements of crispness. Deep-fried breadcrumb coatings of eight sizes were investigated: 4.0 mm, 2.8 mm, 2.0 mm, 1.4 mm, 1.0 mm, 710 µm, 500 µm, and 355 µm. Sensory profiling was carried out to develop a tailored lexicon for deep-fried battered and breaded shrimp. Principal component analysis highlights that large breadcrumb sizes correlate with crispness, hardness, particle size, surface color, color uniformity, surface irregularity, total porosity, maximum force, area, drop in force, number of sound peaks, and sound pressure level. Agglomerative hierarchical clustering was used to confirm clustering of samples according to breadcrumb size. Multiple factor analysis confirmed overall correlation between sensory measurements and instrumental measurements (RV = 0.810). Partial least squares regression was used to develop a predictive model for crispness from instrumental measurements (R2 = .854). The use of texture analysis and Acoustics provide information of the structures strength and deformation behavior, while X-ray microCT provides a high resolution and noninvasive method that acquires information on the internal morphology. These instrumental methods collectively demonstrate the relationship between microstructure to sensory. This study investigates how a change in the microstructure of deep-fried battered and breaded coatings affect crispness perception. These changes were investigated analytically and by using a sensory panel, this is important from a manufacturing perspective in order to understand what the major contributors are to a crisp texture. The key highlights of this study include both instrumental measurements and sensory measurements can be used to measure crispness as both types of testing are correlated. Changes in the size of breadcrumbs affect both instrumental measurements and sensory measurements. A predictive model can be re-simulated to allow prediction of crispness in deep-fried battered and breaded coatings.

Family Needs on an Inpatient Brain Injury Rehabilitation Unit: A Quantitative Assessment.

OBJECTIVE: To examine the needs of family members in an inpatient setting and factors predicting extent to which needs are perceived as met. SETTING: University health system inpatient rehabilitation unit. PARTICIPANTS: Adult survivors of traumatic brain injury and family members (n = 85). DESIGN: Prospective, cross-sectional. MAIN MEASURE: Family Needs Questionnaire-Revised (FNQ-R). RESULTS: Needs related to the Health Information subscale were most frequently rated as met, whereas needs related to the Instrumental Support and Emotional Support subscales were most frequently rated as unmet. Predictors related to the FNQ-R included family income, gender, and ethnicity. For 4 of 6 subscales, white family members were more likely to rate needs as unmet than minority members. For 3 subscales, females were more likely to rate needs as unmet than males. Greater household income was associated with fewer met needs for 2 subscales. CONCLUSIONS: The ranking of met and unmet needs in the present study was remarkably similar to previous studies within and outside the United States. Clinicians should not assume that families with relatively higher incomes will experience fewer unmet needs. Through structured assessment, clinicians can reveal perceived needs that might have otherwise been unrecognized and facilitate appropriate supports. Findings provide direction for inpatient program development.